Cholecystectomy during intestinal resection not recommended for IBD patients

Removal of the gallbladder (ie, cholecystectomy) is not recommended at the time of intestinal resection among individuals with inflammatory bowel disease (IBD), according to data presented at AIBD 2020.

Patients with IBD, particularly Crohn’s disease (CD), are at an increased risk for the development of gallstones, which might subsequently warrant hospitalization and surgical intervention. [Gastroenterology 2004;126:1504-1517; Inflamm Bowel Dis 2010;16:1598-1619]

However, data shows that cholecystectomy in this group of patients may change biliary physiology, predisposing them to bile acid diarrhoea, which might worsen the clinical course of the disease. [Am J Gastroenterol 2018;113:S336-S337] Other studies reveal that cholecystectomy carried an increased risk of post-surgical complications in this patient setting. [J Crohns Colitis 2013;7:e164-70; Inflamm Bowel Dis 2012;18:1682-1688] As such, the decision to carry out cholecystectomy in individuals with IBD warrants careful consideration.

This retrospective, single-institution chart review comprised data of 370 individuals who did (n=20; 14 with CD and six with ulcerative colitis [UC]) and did not have IBD (n=350) with history of intestinal resection. Most participants were male (85 percent [CD] and 66 percent [UC]). [AIBD 2020, abstract P049]

All patients with CD underwent intestinal surgery, owing to inflammatory complications (including inflammatory masses, fistulas, strictures; n=12), medically refractory disease (n=1), and right colonic adenocarcinoma (n=1). The surgical procedure used in most patients (85 percent) was ileal/ileocaecal resection, while two participants underwent a right hemicolectomy.

All patients with UC also had surgery due to medically refractory disease. Most patients (80 percent) had undergone subtotal colectomy; one had a total colectomy.

There was no difference observed between the IBD and the non-IBD arms in terms of the number of cholecystectomies performed after intestinal resection (10.0 percent vs 9.7 percent; p=0.71).

“[These findings] may inform clinical practice [regarding] the need to empirically perform a cholecystectomy in IBD patients who undergo intestinal resection,” said the researchers. “Our data shows that performing a cholecystectomy at the time of intestinal surgery is not warranted.”

Post-surgical biliary complications

Moreover, there was a low incidence of biliary disease development following intestinal resection. None of the participants with IBD developed biliary disease (ie, cholecystitis, choledocholithiasis, cholangitis, or biliary pancreatitis), while 10, four, four, and one non-IBD patients had these respective complications. Gallstones were reported in two IBD patients and 42 non-IBD patients (p=1.0).

“Although our numbers are small, the presence of IBD was not a significant risk factor for the development of biliary complications after intestinal resection,” said the researchers.