Risk Factors for Postcholecystectomy Diarrhea: A Systematic Review and Meta-Analysis.

Abstract

Objective: To systematically evaluate potential risk-associated factors for postcholecystectomy diarrhea (PCD) and provide evidence to support clinical risk identification.

Methods: A systematic literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, Scopus, CNKI, Wanfang, and VIP from inception to March 2026. Observational studies reporting PCD risk factors in adults were included. Two researchers independently screened studies, extracted data, and assessed quality using the Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality checklist. Meta-analyses were conducted for comparable variables, and evidence quality was assessed using GRADE.

Results: A total of 17 studies including 9148 postcholecystectomy patients, of whom 1493 developed PCD, were analyzed. Alcohol consumption (odds ratio [OR] = 2.10, 95% confidence interval [CI]: 1.24-3.57; moderate GRADE evidence) and nonlow-fat diet (OR = 1.95, 95% CI: 1.15-3.29; moderate GRADE evidence) were associated with increased PCD risk. Postoperative food intolerance was associated with PCD, although its role as an antecedent risk factor remains uncertain because the temporal relationship with diarrhea could not be established. Age analyses showed inconsistent results: younger patients (<50 versus ≥50 years) had higher PCD risk (OR = 3.49, 95% CI: 1.56-7.80; moderate GRADE evidence), whereas continuous age analyses were nonsignificant, suggesting a potential nonlinear association. Evidence for sex, body mass index (BMI), smoking, diabetes, gallbladder function, and psychological factors was limited or inconsistent. Considerable heterogeneity and differences in outcome definitions among studies were noted.

Conclusion: Alcohol consumption and a nonlow-fat diet may represent clinically relevant factors associated with PCD, while postoperative food intolerance requires cautious interpretation because its temporal relationship with diarrhea remains uncertain. Age may have a nonlinear association with PCD, whereas evidence for other factors remains limited or inconsistent. These findings may assist in recognizing patients at increased risk of PCD and inform preoperative counseling and postoperative management. High-quality, multicenter studies with standardized exposure and outcome definitions are warranted to further clarify PCD risk factors.