Prospective evaluation of outcome following laparoscopic cholecystectomy in patients with symptomatic gallstone disease

Submitted by sysadmin2 on Tue, 05/10/2016 - 11:27
Oncology, Gastroenterology and Hepatology Reports,2015,4,1,14-20.
Published:January 2015
Type:Original Article

Prospective evaluation of outcome following laparoscopic cholecystectomy in patients with symptomatic gallstone disease

Sanjay Marwah, Hemendra Mangal, Mahavir Singh, Hardeep Singh, Siddharth Pandey, Himanshu Sharma

Department of Surgery, Pandit Bhagwat Dayal Sharma Post‑Graduate Institute of Medical Sciences, Rohtak, Haryana, India

Abstract:

Background: Laparoscopic cholecystectomy for gallstones picked up on ultrasonography has become a routine surgical practice. During follow up, symptoms persist in many cases indicating that underlying gallstone disease perse might not be fully responsible for the patient’s problems. Aims: To identify various preoperative factors that could predict symptomatic outcome after cholecystectomy. Setting and design: Consecutive patients presenting with symptomatic gallstone disease in a tertiary care center in North India over two years were included in the study. Materials and Methods: All patients underwent elective laparoscopic cholecystectomy and were followed up to six months. Persistence of any pre‑operative symptoms or emergence of new symptoms was recorded. Statistical analysis: Chi square test and student t test were used and value of P < 0.05 was consider significant. The significant variables were combined in a logistic regression model to predict the postoperative outcome. The factors for negative as well positive postoperative outcome were identified separately. Results: Fifty two cases undergoing laparoscopic cholecystectomy were subjected to analysis. Preoperatively, all patients had biliary symptoms and 71.16% patients reported both biliary and dyspeptic symptoms. At 6 months follow up, biliary symptoms improved in more than 90% cases while dyspeptic symptoms improved in 88% cases. Highly significant (P < 0.00) preoperative factors for negative post‑cholecystectomy outcome were frequent episodes of pain requiring repeated hospitalization whereas typical biliary colic and thickened gallbladder wall seen on ultrasound were predictors of positive outcome ( P < 0.05). Conclusions: Laparoscopic cholecystectomy significantly improves symptoms (especially biliary symptoms) in Asian population. The patients presenting with predominant dyspeptic and non‑specific symptoms should be discouraged to undergo cholecystectomy and counseled regarding poor outcome of surgery.