Question explored with the scientific record
Conversation so far
- 1 What is the risk of SOD from cholasectamy
- 2 I meant schinter of Oddi dysfunction
- 3 But what is the risk of this from surgery to remove the gallbladder
Answered on this page ↓
But what is the risk of this from surgery to remove the gallbladder
The short version: the evidence does not give you a clear risk number for sphincter of Oddi dysfunction after gallbladder surgery. The diagnosis itself is the problem.
The evidence here is mostly about how to diagnose SOD after cholecystectomy, not about how often it happens. One 1980 study of 56 patients with post-surgery pain found ampullary stenosis in 40 of them [4]. That is a high rate, but it is a selected group—everyone already had pain. It does not tell you the risk for someone who just had their gallbladder out. A 2001 study of 343 post-cholecystectomy patients found 85 diagnosed with SOD by manometry [1], but again these were people referred for symptoms, not a general sample.
The real risk is not that SOD is common. It is that if you develop pain after surgery, you may enter a diagnostic maze where the tests disagree with each other. Fatty meal sonography caught only 22% of manometry-confirmed cases [1]. Hepatobiliary scintigraphy caught 51% [1]. The non-invasive tests miss most cases, and the invasive test (manometry) carries its own pancreatitis risk. A 2015 trial found that the main treatment, sphincterotomy, was less effective than sham—23% success versus 37%—and caused pancreatitis in 12% of patients [2].
| Test | Sensitivity | Specificity |
|---|---|---|
| Fatty meal sonography | 22% | 97% |
| Hepatobiliary scintigraphy | 51% | 79% |
My call: the risk of developing SOD after cholecystectomy is not well measured in the evidence here. The bigger risk is the cascade of testing and treatment if you develop pain, where the tests are unreliable and the treatment may be worse than doing nothing. Confidence: low—the evidence does not include a study that follows a general group of surgery patients to see how many develop SOD.
Sources examined 13
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Diagnosis of sphincter of Oddi dysfunction (SOD): Comparison of sphincter of Oddi manometry (SOM), fatty meal sonography (FMS), and hepatobiliary scintigraphy (HBS)
This study compares the diagnostic efficacy of sphincter of Oddi manometry (SOM), fatty meal sonography (FMS), and hepatobiliary scintigraphy (HBS) in diagnosing sphincter of Oddi dysfunction (SOD) in a cohort of 343 patients post-cholecystectomy, revealing poor correlation betw…
DOI: 10.1016/s0016-5107(01)80053-5 -
Endoscopic Sphincterotomy for Sphincter of Oddi Dysfunction: Inefficacious Therapy for a Fictitious Disease
This study evaluates the efficacy of endoscopic sphincterotomy for patients with suspected sphincter of Oddi dysfunction, revealing that the procedure is ineffective and does not correlate with manometry findings.
DOI: 10.1053/j.gastro.2014.12.021 -
Laparoscopic pancreatoduodenectomy. Step by step
This document compiles multiple surgical video case reports in hepatobiliary and pancreatic surgery, illustrating techniques and outcomes for postcholecystectomy issues, gallbladder cancer surgery with hepatic segmentectomy, and minimally invasive management of walled-off pancre…
DOI: 10.1016/j.hpb.2017.02.258 -
Postcholecystectomy syndrome and its association with ampullary stenosis
In 56 consecutive post-cholecystectomy patients with recurrent upper abdominal pain, the study used ERCP, morphine neostigmine testing, ultrasound, and other imaging to identify causes of symptoms, finding ampullary stenosis as the most common factor and suggesting preoperative …
DOI: 10.1016/0002-9610(80)90296-2 -
Impact of routine intraoperative cholangiography during laparoscopic cholecystectomy on bile duct injury
This study evaluates the impact of routine intraoperative cholangiography (IOC) during laparoscopic cholecystectomy on the incidence and management of bile duct injuries (BDI), finding that IOC significantly aids in the detection and repair of such injuries with a low complicati…
DOI: 10.1002/bjs.9486 -
Prognostication of Learning Curve on Surgical Management of Vasculobiliary Injuries after Cholecystectomy
This study evaluates the outcomes of surgical management of iatrogenic bile duct injuries with and without concomitant vascular injuries in a new hepatobiliary center during its learning curve, finding that the learning curve does not negatively impact surgical outcomes.
DOI: 10.1155/2016/2647130 -
Delphi consensus on bile duct injuries during laparoscopic cholecystectomy: an evolutionary cul‐de‐sac or the birth pangs of a new technical framework?
This study presents a Delphi consensus among expert surgeons on the prevention of bile duct injuries during laparoscopic cholecystectomy, identifying key surgical techniques and anatomical landmarks to mitigate risks.
DOI: 10.1002/jhbp.503 -
Is There a Role for Endoscopic Therapy as a Definitive Treatment for Post-Laparoscopic Bile Duct Injuries?
This study evaluates the outcomes of endoscopic versus surgical management of post-laparoscopic bile duct injuries (BDIs) and highlights the effectiveness of endoscopic therapy for class A injuries while suggesting that surgical intervention remains the preferred treatment for m…
DOI: 10.1016/j.jamcollsurg.2010.06.013 -
Treatment of failed Roux-en-Y hepaticojejunostomy after post-cholecystectomy bile ducts injuries
This study reports on the outcomes of a multidisciplinary approach to managing failed Roux-en-Y hepaticojejunostomy in patients with post-cholecystectomy bile duct injuries, achieving a clinical success rate of 89% through various surgical and percutaneous interventions.
DOI: 10.1016/j.surg.2012.06.028 -
Single Incision Laparoscopic Cholecystectomy Is Associated With a Higher Bile Duct Injury Rate
This study reviews the incidence of bile duct injuries associated with single incision laparoscopic cholecystectomy (SILC) compared to traditional laparoscopic cholecystectomy (SLC), highlighting a higher injury rate in SILC procedures.
DOI: 10.1097/sla.0b013e3182583fde -
Avulsion of common bile duct after blunt abdominal injury: A review of the literature
This paper reviews 82 cases of common bile duct avulsion following blunt abdominal injury, presenting a new technique for delayed repair that successfully restored duct function in a unique case of complete avulsion.
DOI: 10.1016/0020-1383(83)90096-7 -
Role of Liver Transplantation in Bilio-Vascular Liver Injury After Cholecystectomy
This study reports on two cases of liver transplantation due to iatrogenic bile-vascular injury sustained during cholecystectomy, highlighting the management challenges and outcomes associated with such injuries.
DOI: 10.1016/j.transproceed.2015.12.035 -
Intraoperative cholangiography lowers the risk of bile duct injury during cholecystectomy
This study demonstrates that intraoperative cholangiography (IOC) significantly reduces the risk of bile duct injury during cholecystectomy by enhancing the surgeon's understanding of biliary anatomy and enabling early detection of injuries.
DOI: 10.1007/s00464-006-0122-4