Background

Alterations in gut microbiota are recognized modulators of gastrointestinal and metabolic health, but the clinical relevance of dysbiosis after cholecystectomy remains unclear.

Methods

A retrospective case-control study included adults who underwent cholecystectomy (2020-2023) and developed persistent gastrointestinal/metabolic symptoms postoperatively with fecal microbiota testing. Patients were divided into dysbiosis or eubiosis groups using a predefined scoring system. Baseline characteristics, microbial profiles, and outcomes were compared. Correlations and multivariate regression assessed associations. 75 patients were included (35 dysbiosis, 40 eubiosis).

Results

The dysbiosis group had significantly reduced Bifidobacterium, Lactobacillus and Bacillus spp, and increased Escherichia coli, Clostridium perfringens, Firmicutes-to-Bacteroidetes (F/B) ratio, Enterococcus spp., Klebsiella spp., and Streptococcus spp. (all P < .05). Alpha diversity analysis revealed lower Shannon index and Chao1 index (all P < .05). Dysbiosis was associated with higher rates of diarrhea (51.4% vs 22.5%, P = .010), abdominal distension (42.9% vs 17.5%, P = .018), and ALT elevation (40.0% vs 17.5%, P = 0.031). The F/B ratio positively correlated with ALT (ρ = 0.46, P = .005), while Bifidobacterium inversely correlated with triglycerides (ρ = −0.41, P = 0.011). Dysbiosis was independently associated with a higher risk of postoperative diarrhea (adjusted OR = 2.87; 95% CI: 1.02-8.05; P = 0.046).

Conclusion

Gut microbiota dysbiosis is common post-cholecystectomy and associated with increased risks of postoperative diarrhea and metabolic disturbances. Microbiota profiling may aid risk stratification and guide interventions targeting the gut-liver axis.