Association Between Post-Cholecystectomy Gut Microbiota Dysbiosis and Adverse Clinical Outcomes: A Single-Center Retrospective Case-Control Study

BackgroundAlterations in gut microbiota are recognized modulators of gastrointestinal and metabolic health, but the clinical relevance of dysbiosis after cholecystectomy remains unclear.MethodsA 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).ResultsThe dysbiosis group had significantly reduced <i>Bifidobacterium</i>, <i>Lactobacillus</i> and <i>Bacillus</i> spp, and increased <i>Escherichia coli</i>, <i>Clostridium perfringens</i>, Firmicutes-to-Bacteroidetes (F/B) ratio, <i>Enterococcus</i> spp., <i>Klebsiella</i> spp., and <i>Streptococcus</i> spp. (all <i>P</i> < .05). Alpha diversity analysis revealed lower Shannon index and Chao1 index (all <i>P</i> < .05). Dysbiosis was associated with higher rates of diarrhea (51.4% vs 22.5%, <i>P</i> = .010), abdominal distension (42.9% vs 17.5%, <i>P</i> = .018), and ALT elevation (40.0% vs 17.5%, <i>P</i> = 0.031). The F/B ratio positively correlated with ALT (ρ = 0.46, <i>P</i> = .005), while <i>Bifidobacterium</i> inversely correlated with triglycerides (ρ = -0.41, <i>P</i> = 0.011). Dysbiosis was independently associated with a higher risk of postoperative diarrhea (adjusted OR = 2.87; 95% CI: 1.02-8.05; <i>P</i> = 0.046).ConclusionGut 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.