The present prospective follow-up study aims at the identification and the valuation of predictors of negative symptomatic outcomes at 6 weeks after cholecystectomy.īetween March 2006 and August 2007, all patients between 18 and 65 years with diagnosed cholelithiasis (diagnosis K80 from International Statistical Classification of Diseases and Related Health Problems (ICD-10)), awaiting an elective laparoscopic cholecystectomy at the department of Surgery of the St. Although clinical experience indicates that most patients experience a major reduction of symptoms at 6 weeks post-cholecystectomy, 20 no studies have explored predictors of symptomatic outcome at this time point. In literature, pre-operative dyspeptic symptoms, the use of psychotropic medication, and a long history of pain, symptoms, and biliary attacks are mentioned as potential predictors of poor outcome and persisting pain 17– 19 at 6 months post-cholecystectomy. 8, 17, 18 Thus, recognition of patients with a high risk of negative outcomes is crucial. However, a substantial group of patients report persistence of pre-existent biliary (5.5–19.5%) and dyspeptic symptoms (27.3–43.2%). 1 The majority of patients report positive outcomes and relief rates for biliary pain (86–96%), upper abdominal pain (66–77%), and dyspepsia (46–89%) 13 are high. 16 In the Netherlands, cholecystectomy is performed in 19,000 patients a year. 2Įlective cholecystectomy is widely performed in 70% of the symptomatic patients. In biliary pain without stones, cholecystectomy is occasionally indicated 10 following additional surgical consultation. #PROBLEMS AFTER GALLBLADDER REMOVAL YEARS LATER PROFESSIONAL#11– 14 Professional guidelines propose conservative treatment (wait and see) in asymptomatic cholelithiasis 2, 9, 15 and cholecystectomy in symptomatic cholelithiasis. 10 Additional ultrasonography is recommended, 2, 9, 11 as clinical symptoms are not consistently related to the presence of gallstones. 6– 9 However, some patients experience mild dyspeptic symptoms without biliary colics. 2– 4 Symptomatic gallstone disease is typically diagnosed after an episode of biliary pain, which is defined as a severe steady pain, lasting more than 15–30 min, usually located in the epigastrum and/or right upper quadrant, sometimes radiating to the back, 2, 5 which is often accompanied by dyspeptic symptoms. 1 The majority of patients remains asymptomatic and only 20% of patients develop clinical symptoms. In the Netherlands, 32,000 patients are yearly diagnosed with this condition. Gallstone disease (cholelithiasis) is a common condition in the Western world. Known risk factors for long-term outcomes might be valuable in female patients only. A symptom-specific approach should lead to optimalization of the indication of cholecystectomy and information of patients. Patients with pre-operative dyspeptic symptoms, notably bad taste and flatulence, have an increased risk of negative post-cholecystectomy outcomes at 6 weeks. Predictors of symptomatic outcome were only identified in women, not in men. Pre-operative flatulence was an independent predictor of the report of biliary and dyspeptic symptoms ((OR = 3.33) and (OR = 3.27), respectively) and persisting biliary symptoms (OR = 4.21). ResultsĪt 6 weeks post-operatively, the report of post-operative biliary symptoms was independently predicted by pre-operative dyspeptic symptoms (OR = 6.60) and bad taste (OR = 3.55). Predictors of the persistence and emergence of biliary and dyspeptic symptoms at 6 weeks post-cholecystectomy were investigated using univariate and multivariate logistic regression. At 6 weeks post-operatively, the same self-report questionnaires were completed ( n = 129). MethodsĬonsecutive patients ( n = 183), age 18–65 years, indicated for elective cholecystectomy due to symptomatic cholelithiasis, completed a self-report questionnaire. The current prospective follow-up study aims at the identification and valuation of risk factors for negative symptomatic outcome at 6 weeks. Many patients with symptomatic cholelithiasis report persisting symptoms after elective cholecystectomy.
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