Postcholecystectomy syndromes.

The postcholecystectomy syndrome in its chronic form is characterized by severe episodes of upper abdominal pain that may or may not be accompanied by hepatic or pancreatic dysfunction or ductal dilation. Endoscopic retrograde cholangiopancreatography is the most definitive way to identify anatomic defects. Transendoscopic papillary manometry is a promising new diagnostic technique. A surgical approach should be used only after persistence of symptoms without apparent cause and a prolonged trial of medical therapy. The operation should include exploration of the contents of the peritoneal cavity and transduodenal examination of the papilla of Vater. An extended papilloplasty should be performed to include a 1- to 2-cm anterior sphincteroplasty and an excision of the transampullary septum. Approximately 75 percent of patients with chronic pain after cholecystectomy will gain long-term relief of their symptoms.