BackgroundPostoperative (PO) pain interferes with the recovery and mobilization of the surgical patients. The impact of the educational status has not been studied adequately up to now.MethodsThis prospective study involved 400 consecutive general surgery patients. Various factors known to be associated with the perception of pain including the educational status were recorded as was the preoperative and postoperative pain and the analgesia requirements for the 1st PO week. Based on the educational status, we classified the patients in 3 groups and we compared these groups for the main outcomes: i.e. PO pain and PO analgesia.ResultsThere were 145 patients of lower education (junior school), 150 patients of high education (high school) and 101 of higher education (university). Patients of lower education were found to experience more pain than patients of higher education in all postoperative days (from the 2nd to the 6th). No difference was identified in the type and quantity of the analgesia used. The subgroup analysis showed that patients with depression and young patients (< 40 years) had the maximum effect.ConclusionsThe educational status may be a significant predictor of postoperative pain due to various reasons, including the poor understanding of the preoperative information, the level of anxiety and depression caused by that and the suboptimal request and use of analgesia. Younger patients (< 40), and patients with subclinical depression are mostly affected while there is no impact on patients over 60 years old.
Aim-Background:The aim of the present review is to evidence the differences in the nature of PCS between open and laparoscopic cholecystectomy and also to examine how this condition has evolved over the years. In 5 to 40% of patients with cholelithiasis, regardless of the type of surgery, the symptoms persist postoperatively, leading to the development of the so-called postcholecystectomy syndrome (PCS). The time of the onset of symptoms ranges from 2 days to 25 years after cholecystectomy.Methods: A total number of 926 articles were found as a literature reference pool. We searched English language articles published in Medline, Scopus and google scholar. Only review articles were retrieved because no comparative studies or prospective clinical trials were found to provide statistically significant conclusions. The final group of articles was reviewed, and a total of 57 papers were used for the present review.
Results:The literature is conflicting as concerns the pathophysiology and the aetiology of PCS. Regardless of the type of surgery, it seems that PCS is correlated to age and sex. The prevailing view is that retained or recurrent gallstones, gallbladder remnants and Sphincter of Oddi dysfunction are the primary causes. Moreover, systemic diseases of the gastrointestinal (GI) tract, cardiac disorders, autoimmune diseases, nervous system and psychological distress can mimic PCS symptoms. Nonetheless, there are many available techniques regarding diagnosis and treatment. Nowadays, the majority of researchers endorse ERCP as the gold standard for diagnosis and treatment.
Conclusion:The preoperative meticulous investigation of patients with cholelithiasis is mandatory in order to identify coexisting disorders related to PCS, achieve a better therapeutic approach, and principally reduce PCS incidence.
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