Risk Assessment in Cholelithiasis: Is Cholecystectomy Always to be Preferred?

Abstract

BackgroundAs many patients with gallstone disease do not benefit from cholecystectomy, preoperative recognition of such high-risk patients is important. The aim of the study is to identify predictors of persisting symptoms at 6 months after cholecystectomy for patients with different preoperative symptomatology.Method Participants in this prospective study were consecutive patients (n = 172), age 18–65 years, with symptomatic cholelithiasis, undergoing a laparoscopic cholecystectomy. Predictors were identified using uni- and multivariate regression analyses.ResultsAt 6 months postcholecystectomy, patients with only preoperative biliary symptoms were most often free of symptoms (62.5%). Patients with only dyspeptic symptoms most often reported persistence of preexisting symptoms (63.2%). Preoperative non-specific symptoms predicted the report of postoperative biliary and/or dyspeptic symptoms (OR = 4.5–6.1). Persistence of preexisting pattern of symptoms was predicted by the use of psychotropic medication (OR = 5.3) and dyspeptic symptoms (OR = 4.5). Postoperative biliary symptoms were predicted by High Trait Anxiety (HTA) (OR = 10.6).ConclusionSurgeons should take account of individual risks of patients in the management of cholelithiasis. Instead of cholecystectomy, expectative management should be the first choice in patients with non-specific symptoms, with dyspeptic symptoms only, with HTA and in patients using psychotropic medication.

Consistency of patient-reported outcomes after cholecystectomy and their implications on current surgical practice: a prospective multicenter cohort study

“…We could not establish associations with episodic type of pain and pain-induced awakening at night. Explanations might be found in methodological differences as some studies did not include all patients before surgery, possibly introducing recall bias, and used non-validated questionnaires [16, 32]. However, PROMs are also subjective and easily influenced by patient (environmental and psychological factors) and provider characteristics (hospital- and physician-related factors), leading to variation in time [34].…”

Endoscopic-Laparoscopic Cholecystolithotomy in Treatment of Cholecystolithiasis Compared with Traditional Laparoscopic Cholecystectomy: Erratum

“…Another research showed that the bile excretion dysfunction was perhaps related to high trait anxiety. 14,15 Moreover, cholecystectomy cannot prevent recurrent choledocholithiasis. 16,17 The main findings of our study are as follows: (1) there was no significant difference in operating time and expenses between ELC and LC; (2) ELC showed significantly less blood loss during operation compared with LC; (3) patients who underwent ELC had shortened exhaust time and hospital stay; (4) ELC showed decreased recurrence of dyspepsia and diarrhea in comparison with LC.…”

Black Bile of Melancholy or Gallstones of Biliary Colics: Historical Perspectives on Cholelithiasis

“…The call for caution found its empiric support with more detailed case-control studies, which suggested that frequency rather than the nature of symptoms differed in persons with and without gallstone disease [48]. Importantly, vague dyspeptic symptoms, such as bloating or nausea, were not more common in persons with cholelithiasis [22,26,42], and often also persist after cholecystectomy [49].…”