Searching for low phospholipid associated cholelithiasis among patients with post-cholecystectomy biliary pain

Trinh, A; Tjandra, D; Park, YA; Sood, S; Thomson, B; Speer, T; Buchanan, D; Boussioutas, A; Metz, AJ

Author(s): Trinh, A; Tjandra, D; Park, YA; Sood, S; Thomson, B; Speer, T; Buchanan, D; Boussioutas, A; Metz, AJ;
Details: Publication Year 2024-06,Volume 94,Issue #6,Page 1102-1107
Journal Title: ANZ Journal of Surgery
Publication Type: Research article
Abstract: INTRODUCTION: Low phospholipid associated cholelithiasis (LPAC) is associated with variants of the adenosine triphosphate-binding cassette subfamily B, member 4 (ABCB4) gene and is characterized by reduced phosphatidylcholine secretion into bile, impairing the formation of micelles and thus exposing bile ducts to toxic bile acids and increasing cholesterol saturation. LPAC is present in 1% of patients with gallstones and post-cholecystectomy pain is common in this group. LPAC is an under-appreciated cause of post-cholecystectomy pain. The aim of this study is to assess a cohort of patients with post-cholecystectomy pain to identify those with clinical features suggesting that further investigations for LPAC would be beneficial. METHODS: A retrospective chart review was performed of the first 2 years of post-operative follow-up for all patients under 40 years of age undergoing cholecystectomy for symptomatic gallstones at a tertiary centre between January 2016 and December 2017. RESULTS: 258 patients under the age of 40 underwent a cholecystectomy. 50 patients (19.4%) reported abdominal pain post-cholecystectomy. Five patients (1.9%) fulfilled the criteria for suspected LPAC. Family history of gallstones was documented in 33 of 258 (12.8%) of cases. Obstetric history was obtained in 69 of 197 (35%) female patients. None of the five patients identified above who satisfied the criteria of LPAC had the diagnosis of LPAC considered by their treating clinicians. CONCLUSION: LPAC is an under-recognized cause of post-cholecystectomy pain. Treatment can avoid long-term symptoms and complications. Clinicians should take a family history and obstetric history to alert them to the diagnosis of LPAC.
Publisher: Wiley
Keywords: Humans; Female; Retrospective Studies; Male; Adult; *Cholelithiasis/surgery/complications; *Pain, Postoperative/etiology; *Cholecystectomy/adverse effects; *Phospholipids/metabolism; ATP Binding Cassette Transporter, Subfamily B/genetics/metabolism; Gallstones/surgery/complications; Young Adult; Abdominal Pain/etiology; adenosine triphosphate‐binding cassette subfamily B, member 4 – ABCB4; audit; low phospholipid associated cholelithiasis; post‐cholecystectomy pain
Department(s): Ambulatory Services; Surgical Oncology
Publisher's Version: https://doi.org/10.1111/ans.18904
Open Access at Publisher's Site: https://doi.org/10.1111/ans.18904
Terms of Use/Rights Notice: Refer to copyright notice on published article.

Creation Date: 2024-08-27 07:27:57

Last Modified: 2024-08-27 07:28:27