Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up

The expectation that cholecystectomy is effective treatment for symptomatic gallstones is not always achieved in surgical practice. The impact of cholecystectomy on the relief of gastrointestinal symptoms was evaluated in 92 patients followed up after surgery for a mean of 31.1 months (range 12-83 m...

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Bibliographic Details
Published in:Annals of the Royal College of Surgeons of England 1998-01, Vol.80 (1), p.25-32
Main Authors: Gui, G P, Cheruvu, C V, West, N, Sivaniah, K, Fiennes, A G
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Cholecystectomy
Cholelithiasis - complications
Cholelithiasis - surgery
Female
Follow-Up Studies
Gastrointestinal Diseases - etiology
Humans
Logistic Models
Male
Middle Aged
Pain, Postoperative
Patient Selection
Retrospective Studies
Risk Factors
Treatment Outcome
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Summary:The expectation that cholecystectomy is effective treatment for symptomatic gallstones is not always achieved in surgical practice. The impact of cholecystectomy on the relief of gastrointestinal symptoms was evaluated in 92 patients followed up after surgery for a mean of 31.1 months (range 12-83 months). Abdominal pain continued to be present, or arose de novo, in 28 (30.4%) patients. Pain-free outcome after cholecystectomy was associated with a preoperative clinical diagnosis of biliary colic, fatty food intolerance, and a thick-walled gallbladder on ultrasound (P = 0.02). Logistic regression associated a thick-walled gallbladder, elevated gamma-glutamyl transpetidase, body mass index < 26, fat intolerance, and normal bowel habit with good postoperative results (P = 0.001). Application of each of these five factors to a clinical index failed to predict long-term pain-free outcome after cholecystectomy. Abdominal bloating (P = 0.03), dyspepsia (P < 0.001), heartburn (P < 0.007), fat intolerance (P < 0.001), nausea (P = 0.001) and vomiting (P < 0.001) were significantly improved after cholecystectomy, but diarrhoea, constipation and excessive flatus were not. Outcome benefit ratios confirmed that vomiting (0.96), nausea (0.87), dyspepsia (0.67), fat intolerance (0.57) and heartburn (0.51) were relieved by surgery. Cholecystectomy improved symptoms compared with a matched control group, suggesting that surgery remains the gold standard treatment of symptomatic gallstones.
ISSN:0035-8843
1478-7083