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

Andrew Trinh; Doug Tjandra; Yeung-Ae Park; Siddharth Sood; Benjamin Thomson; Tony Speer; Daniel Buchanan; Alex Boussioutas; Andrew J Metz

doi:10.1111/ans.18904

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

ANZ J Surg. 2024 Feb 15. doi: 10.1111/ans.18904. Online ahead of print.

Authors

Andrew Trinh^{1

2

3}, Doug Tjandra², Yeung-Ae Park², Siddharth Sood², Benjamin Thomson⁴, Tony Speer², Daniel Buchanan^{5

6

7}, Alex Boussioutas^{1

3

8}, Andrew J Metz^{1

2}

Affiliations

¹ Department of Medicine, Royal Melbourne Hospital and The University of Melbourne, Parkville, Victoria, Australia.
² Department of Gastroenterology, Royal Melbourne Hospital, Parkville, Victoria, Australia.
³ Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
⁴ Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
⁵ Colorectal Oncogenomics Group, Genetic Epidemiology Laboratory, Department of Pathology, The University of Melbourne, Parkville, Victoria, Australia.
⁶ Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
⁷ University of Melbourne Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Parkville, Victoria, Australia.
⁸ Department of Gastroenterology, The Alfred and Monash University, Melbourne, Victoria, Australia.

PMID: 38361311
DOI: 10.1111/ans.18904

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.

Keywords: adenosine triphosphate-binding cassette subfamily B, member 4 - ABCB4; audit; low phospholipid associated cholelithiasis; post-cholecystectomy pain.