Fate of dyspeptic symptoms following Lap. cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. Symptoms of abdominal pain, nausea, food intolerance, and others are common, and their relationship to biliary disease is often well known but other Gastro-Intestinal conditions may cause them also. Continuation of such symptoms post-operatively is the target of this study. Aim of study: To assess the incidence, etiology, management and preventing measures of persistent dyspeptic symptoms following laparoscopic cholecystectomy. Patients and methods: This is a Prospective study performed in Al-Fallujah teaching hospital on One hundred thirty six patients undergoing laparoscopic cholecystectomy between September 2016 and September 2017. They were evaluated using a questionnaire for data collection; inquiring about: indication for laparoscopic cholecystectomy, characteristics of pain, and other associated dyspeptic and colonic symptoms. The patients were re-evaluated with the same questionnaires after surgery during a period from 2-12 weeks, and classified into two groups: first group includes patients get benefit of surgery (relieved symptoms) and those whom symptoms not eliminated by surgery (persistent symptoms). 21 patients were excluded from our analysis; five of them had conversion to open surgery & we lost contact with sixteen patients post-operatively. Results: The median age of the remaining 115 patients was 34.4 year (range 17-55) years; 20 were men. All were diagnosed to have symptomatic gall stones disease and all were scheduled for laparoscopic cholecystectomy (L.C.). 16 patients (13.9%) had persistent symptoms post-operatively during the followup period. Our study concentrated on the correlation between the preoperative presentation and the continuation of post-operative symptoms. Statistical analysis showed that food intolerance and nausea were more common among those with a poor outcome after laparoscopic cholecystectomy. Patients with persistent dyspeptic symptoms despite operation; their symptoms were indeed belongs to GERD and P.U disease in the majority of them. Conclusion: Nonspecific dyspeptic symptoms like heartburn, food intolerance and nausea are not adequate reasons for taking the decision of laparoscopic cholecystectomy. Patients with dyspeptic, or colonic symptoms should be thoroughly evaluated to avoid unnecessary cholecystectomy in those with other Gastro-Intestinal pathology that share the same symptoms of Gallstones.

Redefining acute acalculous cholecystitis: insights into its systemic inflammatory implications

“…Patient symptom relief has been marginal, with at best 40% experiencing symptom relief following cholecystectomy. 4,5 More recently, authors have proposed that acute acalculous cholecystitis may be a systemic disease, explaining why cholecystectomy does not relieve symptoms in most sufferers. 6,7 Figure 1 Chronic acalculous cholecystitis with simultaneous upper GI inflammation.…”