Life style and outcome following open cholecystectomy

ABSTRACT

Gallstone disease remains one of the most common medical problems leading to surgical intervention. The Increasing number of cholecystectomy has increased the need to assess the effects of the surgery on presenting symptoms. Cholecystectomy is intended to relieve symptoms of gallstones, but unfortunately some patients will experience post-cholecystectomy symptoms, including pain. There is limited information in the literature on gallstone-related pain and its influence on quality of life. The aim of this study is to investigate whether preoperative variables could predict the symptomatic outcome after cholecystectomy. This study examined symptomatology and quality of life following elective cholecystectomy for symptomatic gallstone disease with defined indications for surgery. Eighty three patients had open cholecystectomy in charity teaching hospital during the period between March 2007 and March 2008. Preoperative data on pain, symptoms, and history was recorded, and the questionnaire on pain and symptoms was filled 1 year postoperatively. Preoperative sonography evaluated gallbladder motility, gallstones, and gallbladder volume. Preoperative variables in patients with or without post-cholecystectomy pain were compared statistically, and significant variables were combined in a logistic regression model to predict the postoperative outcome. The results show that sixty eight patients completed all questionnaires. 54 of patients [80%] had documented gallstones preoperatively, 44 [64.7%] had biliary pain and 49 [72%] had both biliary pain and documented gallstones prior to surgery. Twenty three patients had some pain postoperatively. Of these thirteen patients continued to have abdominal pain after the operation. Patients with pain 1 year after cholecystectomy were characterized by the preoperative presence of a high dyspepsia score, 'irritating' abdominal pain, and an Introverted personality and by the absence of 'agonizing' pain and of symptoms coinciding with pain [P < 0.003]. In a constructed logistic regression model 8 of 11 predicted patients had postoperative pain [PV pos = 0.73]. Of 57 patients predicted as having no pain postoperatively, 52 were pain-free [PV neg = 0.91]. The cure rate for biliary colic was 85% if stones were documented preoperatively, and 49% when they were not [P< 0.05]. It was concluded that most patients [81%] with biliary colic and gallstones have complete relief of upper abdominal pain after cholecystectomy. Pain relief in patients felt to have acalculus cholecystitis was only 52%. Non-pain symptoms were common preoperatively [82%] and were relieved in 44% of patients