Editor,
We would like to thank the author for his interest in our article [1]. We agree that post cholecystectomy pain (PCP) syndrome is poorly understood. The aim of our article was to highlight myofascial pain syndrome as an often undiagnosed cause of PCP syndrome and detail its management.
The author suggests post-operative adhesions as a potential cause for PCP. It is well documented that adhesions can cause persistent abdominal pain after open surgery [2]. The article quoted by the author suggests adhesions as a possible cause for PCP in patients who underwent open cholecystectomy [3]. Laparoscopic surgery is minimally invasive and the incidence of readmissions as a result of postoperative adhesions is reported to be significantly lower compared to open surgery [4]. In addition, a majority of postoperative adhesions remain clinically silent [2]. In theory, postoperative adhesions following laparoscopic cholecystectomy could be a potential cause for PCP syndrome. However, its management remains obscure as any surgery to remove adhesions risks the development of further adhesions [2].
References
[1] Lee H, Askar A, Makanji D, Ranjha K, Karki BB, Courcol J, et al. The incidence of post cholecystectomy pain (PCP) syndrome at 12 months following laparoscopic cholecystectomy: a prospective evaluation in 200 patients. Scand J Pain. 2023;24(1):20230067. 10.1515/sjpain-2023-0067.Search in Google Scholar PubMed
[2] Moris D, Chakedis J, Rahnemai-Azar AA, Wilson A, Hennessy MM, Athanasiou A, et al. Postoperative abdominal adhesions: clinical significance and advances in prevention and management. J Gastrointest Surg. 2017;21:1713–22.10.1007/s11605-017-3488-9Search in Google Scholar PubMed
[3] Arora D, Kaushik R, Kaur R, Sachdev A. Post-cholecystectomy syndrome: A new look at an old problem. J Minim Access Surg. 2018;14(3):202–7.10.4103/jmas.JMAS_92_17Search in Google Scholar PubMed PubMed Central
[4] Krielen P, Stommel MW, Pargmae P, Bouvy ND, Bakkum EA, Ellis H, et al. Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update). Lancet. 2020;395(10217):33–41.10.1016/S0140-6736(19)32636-4Search in Google Scholar PubMed
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