Cholecystectomy-induced gut dysbiosis and its consequences: bridging animal models and clinical outcomes in narrative review.

Background and Objective: Cholecystectomy is a commonly performed surgical procedure that alters bile acid storage and secretion, leading to continuous bile flow and disruption of the enterohepatic circulation. These alterations may increase colonic bile acid exposure and disrupt gut microbiota composition, contributing to intestinal inflammation, metabolic disturbances, and potential long-term complications. However, the underlying mechanisms and clinical implications remain incompletely understood. This review aims to summarize current evidence on the impact of cholecystectomy on gut microbiota composition and its potential associations with metabolic alterations and clinical outcomes. Methods: A narrative review was conducted based on published clinical and Key Content and Findings: Cholecystectomy results in continuous bile acid secretion into the intestine, which may alter bile acid composition and contribute to gut dysbiosis. Both clinical and animal studies suggest that these alterations are associated with intestinal inflammation. This inflammation has been associated with post-cholecystectomy diarrhea, metabolic disturbances that may progress to metabolic syndrome, and an increased long-term risk of colorectal cancer. Additional factors, including a high-fat diet and bile acid-modulating therapies, may further influence microbial composition. However, findings remain heterogeneous across studies, and causal relationships in humans have not yet been firmly established. Conclusions: Cholecystectomy is associated with alterations in gut microbiota and bile acid metabolism that may affect intestinal and metabolic homeostasis. However, human evidence remains limited and heterogeneous, and causality has not been established.