Can cholestatic liver disease occur after a cholecystectomy (surgical removal of the gallbladder)?

From the Guidelines

Yes, cholestatic liver disease can occur after a cholecystectomy, as bile duct injuries (BDIs) are a known complication of the procedure, with an estimated incidence of 0.4-1.5% 1.

Bile Duct Injuries

• BDIs can lead to cholestatic liver disease, characterized by a reduction or stoppage of bile flow, resulting in the accumulation of bile in the liver and potentially causing liver damage.
• The management of BDIs is a surgical challenge, requiring prompt identification and treatment to prevent long-term sequelae, such as morbidity, mortality, and reduced quality of life 1.

Incidence of Bile Duct Injuries

• The incidence of BDIs varies depending on the population, criteria used, and definition of BDI, with reported rates ranging from 0.32 to 0.52% 1.
• Laparoscopic cholecystectomy is associated with a higher incidence of BDIs compared to open cholecystectomy, with rates of 1.3% and 2.8%, respectively, according to the Swedish National Quality Registry of Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) 1.

Risk Factors

• Inflammation (acute or chronic) and emergency cholecystectomy are associated with a higher incidence of BDIs 1.
• Patients with acute cholecystitis (AC) at the time of surgery or with a positive history of AC are at higher risk of BDI, which can be reduced by performing intraoperative cholangiography (IOC) 1.

From the Research

Cholestatic Liver Disease After Cholecystectomy

• Cholestatic liver disease can occur after a cholecystectomy, as evidenced by studies that have investigated the association between cholecystectomy and liver disease 2, 3, 4, 5.
• A systematic review and meta-analysis of 27 million individuals found that cholecystectomy was associated with an increased risk of liver disease, including nonalcoholic fatty liver disease, cirrhosis, and primary liver cancer 2.
• A population-based propensity score-matched study found that cholecystectomy was associated with a higher risk of liver fibrosis and cirrhosis among US adults 3.
• A case series study found that liver resection may be necessary in certain cases of post-cholecystectomy biliary injury, highlighting the potential for liver disease after cholecystectomy 6.
• A study on liver changes associated with cholecystitis found that liver disease may progress to secondary biliary cirrhosis if the obstruction is not relieved, emphasizing the need for early surgery 4.
• Another study suggested that cholecystectomy may itself represent a risk factor for nonalcoholic fatty liver disease (NAFLD), which is in line with the role of the gallbladder and bile acids in systemic metabolic regulation 5.

Risk Factors and Associations

• The studies suggest that cholecystectomy is associated with an increased risk of liver disease, including:
  • Nonalcoholic fatty liver disease (NAFLD) 2, 5
  • Cirrhosis 2, 3
  • Primary liver cancer 2
  • Liver fibrosis 3
• The risk factors for liver disease after cholecystectomy are not fully understood, but may include:
  • Metabolic syndrome 5
  • Bile duct obstruction 4
  • Vascular injuries and liver atrophy 6