Impact of Choice of Therapeutic Strategy for Acute Cholecystitis on Patient’s Health-Related Quality of Life

Abstract

Background: The aim of this prospective, randomized study was to determine if health related quality of life is affected by the choice of surgical strategy in the management of acute cholecystitis. Material and Methods: After diagnostic workup, patients were randomized to one of two groups: (1) early laparoscopic cholecystectomy (i.e. within 7 days after onset of symptoms) or (2) initial conservative treatment followed by delayed laparoscopic cholecystectomy. Seventy-four patients entered the early operation group and 71 patients were assigned to the delayed operation strategy. Assessments of quality of life were made at 1, 3 and 6 months after surgery, and in the delayed operation group also one month after the initial conservative treatment. Results: The gastrointestinal symptom scores were significantly better in three dimensions (diarrhea, indigestion, abdominal pain) one month after surgery for the acute operation group (p < 0.01). Three and 6 months after the operation we were unable to detect any significant differences between the groups. The patients in the delayed operation group did not appear to suffer from more symptoms in the period of time waiting for their elective operation. Psychological general well-being showed no major differences between the groups. Conclusion: Cholecystectomy in the acute phase of acute cholecystitis offers a significant reduction of gastrointestinal symptoms during the first postoperative month and to that associated improved quality of life in this group of patients.

Early versus Delayed Surgery for Acute Cholecystitis as an Applied Treatment Strategy When Assessed in a Population-Based Cohort

“…The somewhat higher proportion of early laparoscopic procedures that had to be converted to an open procedure is predictable and reflects good clinical judgment. Studies from specialized centers show no major differences in complexity and conversion rates between EC versus DC [9,10,11,12,13,14,15,16]. In the present study, the conversion rate was higher than that reported from specialized centers (tables 2, 3).…”

“…In recent decades, evidence has gathered showing that early cholecystectomy (EC) for AC during the acute hospital stay is safe, effective and cost-effective [6,7,8]. Lately, data have emerged from centers with great experience in laparoscopic surgery, that early laparoscopic cholecystectomy (ELC) is an attractive, feasible and safe therapeutic strategy [9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. In fact a recent meta-analysis concluded that ELC appears to be safe and reduces total hospital stay [9].…”

Early Laparoscopic Cholecystectomy Service Provision is Feasible and Safe in the Current UK National Health Service

“…2 Early LC has also been shown to improve quality of life. 3 Few hospitals in the UK routinely perform early LC for acute gallstone diseases due to lack of manpower and resources. 4 Time restrictions on emergency theatre lists often means that patients are discharged after an index emergency admission with plans for re-admission for a delayed-interval cholecystectomy.…”

Removing Symptomatic Gallstones at their First Emergency Presentation

“…This should lead to a longterm decrease in the number of presentations and admissions with symptomatic gallstones and thus reduce morbidity, increasing quality of life of patients. 3 Those presenting through out-patients should continue to be managed with interval laparoscopic cholecystectomy, preferably as daycases. Resources would thus be more effectively and efficiently allocated.…”

“…2 Laparoscopic cholecystectomy during the early phase of acute cholecystitis has been shown to reduce postoperative gastrointestinal symptoms and improve quality of life. 3 In a meta-analysis of randomised controlled trials, no advantage was found to delaying laparoscopic cholecystectomy for acute cholecystitis in morbidity or conversion rates to open operations. 4 Lower rates of conversion to open have been reported in calculous acute cholecystitis if laparoscopic cholecystectomy is undertaken within 48 h of the first acute admission.…”