Prospective 6 Weeks Follow-up Post-cholecystectomy: The Predictive Value of Pre-Operative Symptoms

Abstract

Objective Many patients with symptomatic cholelithiasis report persisting symptoms after elective cholecystectomy. The current prospective follow-up study aims at the identification and valuation of risk factors for negative symptomatic outcome at 6 weeks. Methods Consecutive patients (n=183), age 18-65 years, indicated for elective cholecystectomy due to symptomatic cholelithiasis, completed a self-report questionnaire. At 6 weeks post-operatively, the same self-report questionnaires were completed (n=129). Predictors of the persistence and emergence of biliary and dyspeptic symptoms at 6 weeks postcholecystectomy were investigated using univariate and multivariate logistic regression. Results At 6 weeks post-operatively, the report of post-operative biliary symptoms was independently predicted by preoperative dyspeptic symptoms (OR=6.60) and bad taste (OR=3.55). 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). Predictors of symptomatic outcome were only identified in women, not in men. Conclusion Patients with pre-operative dyspeptic symptoms, notably bad taste and flatulence, have an increased risk of negative post-cholecystectomy outcomes at 6 weeks. A symptom-specific approach should lead to optimalization of the indication of cholecystectomy and information of patients. Known risk factors for long-term outcomes might be valuable in female patients only.

Persistence of Symptoms After Laparoscopic Cholecystectomy

“…In female group, we found that pain, nausea, vomiting and flatulence persisted for a longer duration during postoperative period when compared to males, which is in accordance with the study of Mertens et al (29), concluding that predictors of post-operative symptomatic outcome have only been identified in female patients, however sex is not predictor of post-operative outcome.…”

“…In male group, we found that all the symptoms decreased postoperatively which is in accordance with the study entitled 'Prospective 6 weeks follow-up postcholecystectomy: the predictive value of pre-operative symptoms', conducted by Mertens et al (29), which concludes that predictors of symptomatic outcome were only identified in women not in men, and also stated that known risk factors for long term outcome might be valuable in female patients only.…”

A Randomized Controlled Study of Uncomplicated Gallstone Disease with a 14-Year Follow-Up Showed that Operation Was the Preferred Treatment

“…What constitutes ‘true’ biliary pain or colic is a problem concerning which the medical community and literature lack complete agreement [9,10]. Halldestam et al [11] suggested a definition of severity consistent with our own working terms.…”

Is laparoscopic cholecystectomy effective in relieving dyspepsia in patients of cholelithiasis? A prospective study

“…However, they observed persistence of dyspeptic symptoms in 10-40% of their patients, which could be ascribed to the shorter follow up in the study. 7 The divergent results could also be due to the lack of an objective assessment by use of dyspepsia scores.…”

“…6 In a prospective study, Mertens et al found that dyspeptic symptoms persisted even after a follow-up of 6 weeks after surgery. 7 On the contrary, a prospective interventional study by Guiet al that analyzed the effect of laparoscopic cholecystectomy on dyspeptic symptoms showed promising results. 8 A study published by Niranjan et al in 2000 has reported significant improvement in the majority of dyspeptic symptoms following cholecystectomy.…”