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The Symptomatic Outcomes of Cholecystectomy for Gallstones. J Clin Med 2023; 12:jcm12051897. [PMID: 36902684 PMCID: PMC10004100 DOI: 10.3390/jcm12051897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/08/2023] Open
Abstract
Cholecystectomy is the definite treatment for symptomatic gallstones, and rates are rapidly rising. Symptomatic complicated gallstones are generally treated with cholecystectomy, but there is no consensus on the clinical selection of patients with symptomatic uncomplicated gallstones for cholecystectomy. The aim of this review is to describe symptomatic outcomes before versus after cholecystectomy in patients with symptomatic gallstones as reported in prospective clinical studies and to discuss patient selection for cholecystectomy. Following cholecystectomy, resolution of biliary pain is high and reported for 66-100%. Dyspepsia has an intermediate resolution of 41-91% and may co-exist with biliary pain but may also develop following cholecystectomy with an increase of 150%. Diarrhea has a high increase and debuts in 14-17%. Persisting symptoms are mainly determined by preoperative dyspepsia, functional disorders, atypical pain locations, longer duration of symptoms, and poor psychological or physical health. Patient satisfaction following cholecystectomy is high and may reflect symptom alleviation or a change in symptoms. Comparison of symptomatic outcomes in available prospective clinical studies is limited by variations in preoperative symptoms, clinical presentations, and clinical management of post-cholecystectomy symptoms. When selecting patients with biliary pain only in a randomized controlled trial, 30-40% still have persisting pain. Strategies for the selection of patients with symptomatic uncomplicated gallstones based on symptoms alone are exhausted. For the development of a selection strategy, future studies should explore the impact of objective determinants for symptomatic gallstones on pain relief following cholecystectomy.
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Health-related quality of life among patients with gallstone disease: a systematic review and meta-analysis of EQ-5D utility scores. Qual Life Res 2022; 31:2259-2266. [PMID: 35031978 DOI: 10.1007/s11136-021-03067-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Gallstone disease or cholelithiasis is a chronic illness that usually presents with pain in the abdomen, vomiting and indigestion leading to impaired quality of life. EQ-5D utility score is a validated measure of health-related quality of life (HRQoL). We systematically reviewed the literature and synthesised EQ-5D utility scores among patients with gallstone disease and its improvement on treatment. METHODS We have systematically searched observational studies reporting EQ-5D utility scores of gallstone disease in PubMed, Scopus, and Embase databases, from inception until February 2021. We selected the studies adhering to the PRISMA guidelines. The selected studies were reviewed, and the EQ-5D utility values of pre and post cholecystectomy were pooled using the random-effects model. RESULT From identified 4,817 records of database search, eleven studies predominantly from western countries with 2,189 participants were included for systematic review and meta-analysis. The pooled EQ-5D and visual analogue scores were 0.87 (0.82 to 0.91, I2 = 93.73%) and 83.30 (60.59 to 106.12, I2 = 99.30%) respectively with high heterogeneity. The pooled EQ-5D and EQ-5D visual analogue scores post cholecystectomy treatment were 0.93 (0.91 to 0.95, I2 = 90.17%) and 91.7 (85.99 to 96.35, I2 = 97.93%) respectively. The mean difference between the baseline and post intervention were 0.05 (0.01 to 0.10, I2 = 93.50%) and 10.58 (-8.63 to 29.79, I2 = 98.32%) for EQ-5D and visual analogue scores respectively with high heterogeneity between the studies. CONCLUSION The pooled mean difference indicates improvement in HRQoL after cholecystectomy but with high heterogeneity. Further high-quality studies from Asian countries are required for globally representative quantification and precise estimates of HRQoL among gallstone diseases. PROSPERO REGISTRATION ID CRD42021234467.
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Zeng H, Wang W, Cao L, Wu Y, Ouyang W, Diao D, Wan J, Chen Q, Chen Z. OUP accepted manuscript. Gastroenterol Rep (Oxf) 2022; 10:goac004. [PMID: 35186297 PMCID: PMC8849281 DOI: 10.1093/gastro/goac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/10/2021] [Accepted: 01/19/2022] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusions
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Affiliation(s)
- Haiping Zeng
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P. R. China
- Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Wei Wang
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Lixing Cao
- Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Yuyan Wu
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P. R. China
- Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Wenwei Ouyang
- Key Unit of Methodology in Clinical Research, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, P. R. China
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Dechang Diao
- Department of Colorectal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Jin Wan
- Department of Gastrointestinal Surgery, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Qicheng Chen
- Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
| | - Zhiqiang Chen
- Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, P. R. China
- Corresponding author. Center of TCM applications Perioperative, Guangdong Provincial Hospital of Chinese Medicine, 111 Dade Road, Guangzhou 510120, P. R. China. Tel: +86-20-81887233; Fax: +86-20-81884259;
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Gach T, Bogacki P, Markowska B, Bonior J, Paplaczyk M, Szura M. Quality of life in patients after laparoscopic cholecystectomy due to gallstone disease – evaluation of long-term postoperative results. POLISH JOURNAL OF SURGERY 2021; 93:19-24. [DOI: 10.5604/01.3001.0015.4213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Currently, the standard treatment of gallstone disease is laparoscopic cholecystectomy. Considering its availability, reduction of postoperative pain and shortened stay in the hospital, a constant upward trend in the number of such procedures is observed. However, about one third of patients undergoing such treatment report pain and dyspeptic disorders following the surgery. The assessment of the quality of life of patients undergoing laparoscopic cholecystectomy, based on standardized questionnaires, should be one of the elements allowing for the assessment of the impact of the applied treatment on patients' lives. </br></br> <b>Aim:</b> The aim of this retrospective study is to evaluate the impact of laparoscopic cholecystectomy on the quality of life of patients operated in one center. </br></br> <b>Materials and methods:</b> The study has been carried out retrospectively with the use of a GIQLI questionnaire completed online by the patients 6 months after undergoing laparoscopic cholecystectomy. The study included patients over 18 years of age who have not experienced any complications within the perioperative period and did not require open surgery. The study group has been divided into two subgroups depending on the presence of symptoms of acute gallstone disease in the pre-operative period. </br></br> <b>Results: </b>The study group consisted of 205 patients (53 men, 152 women, aged 19 to 87, with an average of 54.3). The subgroup with an asymptomatic gallstone disease (dyspeptic disorders, without biliary colic) consisted of 47 patients (18 men, 29 women, aged 19–87). Symptomatic gallstone disease occurred in 158 people (35 men, 123 women aged 22 to 81). There have been certain statistically significant differences in the post-operative health condition between the group of patients with symptoms of gallstone disease and the asymptomatic patients. 94.3% of symptomatic patients concluded that their condition has improved and 5.7% that it remained unchanged. Among asymptomatic patients, only 53.2% of patients stated that they felt better post-surgery, 44.7% reported no changes (p < 0.001). There have been no significant differences in the overall QIQLI scores between these subgroups, although symptomatic patients assessed their social functioning better (8.9 ±1.5 vs 8.11 ±2.08, p = 0.004). There have been certain differences between men and women in the assessment of the quality of life in the context of the presence of key symptoms (M: 28.87 ±4.23, F: 26.77 ±5.0, p = 0.007). </br></br> <b> Conclusion:</b> The patients with a symptomatic gallstone disease report they feel better after laparoscopic cholecystectomy as compared to the group of asymptomatic patients. The overall QOL score measured by the GIQLI form does not depend on the presence of symptoms in the preoperative period. Men benefited more from surgery as regards key symptoms.
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Affiliation(s)
- Tomasz Gach
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Paweł Bogacki
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Beata Markowska
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Joanna Bonior
- Department of Medical Physiology, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Małgorzata Paplaczyk
- Department of Clinical Nursing, Institute of Nursing and Midwifery, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
| | - Mirosław Szura
- Department of Surgery, Institute of Physiotherapy, Faculty of Health Sciences, Jagiellonian University Medical College, Poland
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Sutherland JM, Albanese CM, Crump T, Liu G, Karimuddin A. The minimally important difference of the Gastrointestinal Quality of Life Index for symptomatic gallstone surgery. Surg Endosc 2021; 35:6938-6948. [PMID: 33398564 PMCID: PMC8599231 DOI: 10.1007/s00464-020-08205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 12/02/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The Gastrointestinal Quality of Life Index (GQLI) is used to measure domains of health and symptoms among people with gastrointestinal disorders. The objective of this study is to calculate the smallest change in the GQLI that is perceived by patients as meaningful among a sample of English-speaking adult patients undergoing elective laparoscopic cholecystectomy for treatment of symptomatic gallbladder disease. MATERIALS AND METHODS The study is based on retrospective analyses of a sample of participants completing the GQLI and the EQ-5D(3L) preoperatively and six months postoperatively in Vancouver, Canada. Patients are excluded if they are less than 19 years of age, cannot communicate in English, or reside in a long-term care facility. The MID is calculated for the GQLI's domains using distribution and anchor-based methods. RESULTS Among eligible patients, the participation rate was 51%. The estimated MID for the overall GQLI value ranged between 4.32 and 11.44. There were no statistically significant differences in the GQLI's MID values between sexes or age subgroups. There were statistically significant differences in the GQLI's MID values by baseline health status. DISCUSSION This study should provide some comfort that the MID values used in discussing change in health and symptoms with elective cholecystectomy patients are robust to sex. Although the sample size may have been inadequate for age-based analyses, the study found large differences in MID values between age subgroups. Statistically significant differences in MID values based on preoperative health supports reporting MID values separately by baseline value. Further research should explore whether age-based differences in MID values exist using larger samples.
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Affiliation(s)
- Jason M Sutherland
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, V6T 1Z3, Canada.
| | - Carmela Melina Albanese
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, V6T 1Z3, Canada
| | - Trafford Crump
- Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Guiping Liu
- Centre for Health Services and Policy Research, School of Population and Public Health, University of British Columbia, 201-2206 East Mall, Vancouver, V6T 1Z3, Canada
| | - Ahmer Karimuddin
- Section of Colorectal Surgery, Department of Surgery, University of British Columbia, Vancouver, Canada
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Hatton GE, Mueck KM, Leal IM, Wei S, Ko TC, Kao LS. Timely Care is Patient-Centered Care for Patients with Acute Cholecystitis at a Safety-Net Hospital. World J Surg 2021; 45:72-78. [PMID: 32915281 PMCID: PMC7789933 DOI: 10.1007/s00268-020-05764-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Multiple strategies exist to improve the timeliness and efficiency of surgical care at safety-net hospitals (SNH), such as acute care surgery models and nighttime surgery. However, the patient-centeredness of such approaches is unknown. METHODS Adults ( ≥18 years) with acute cholecystitis were interviewed upon admission to a SNH. Interviews were semi-structured and designed to obtain both exploratory qualitative data and ratings of patient-centered outcomes, ranked by importance to the patient. Outcomes included for rating were general health, symptom status, quality of life, and return to prior functional status. Latent content analysis applying inductive coding methods were used to code and condense raw qualitative data from interview transcripts. RESULTS Thematic saturation was reached with a sample size of 15 patients. Most participants were female (87%), Hispanic (87%), and had prior diagnosis of benign biliary disease (60%). Patients identified symptom resolution as the highest-ranked outcome in their treatment. Themes expressed by patients during the exploratory segments of the interview included: desire for pain alleviation, frustration with delays to both symptom resolution and surgical intervention, lack of perceived control over their health care, and reticence in discussing preferences with physicians. All patients preferred to have surgical treatment as soon as possible, even if that meant having nighttime surgery. CONCLUSIONS Effective and timely resolution of symptoms is of utmost importance to patients with acute cholecystitis at a SNH. Efforts to improve timeliness of surgical care are also perceived as patient-centered.
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Affiliation(s)
- Gabrielle E Hatton
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA.
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA.
| | - Krislynn M Mueck
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Isabel M Leal
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX, USA
| | - Shuyan Wei
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at UTHealth, 6410 Fannin Street Suite 471, Houston, TX, 77030, USA
- Center for Surgical Trials and Evidence-Based Practice, McGovern Medical School at UTHealth, Houston, TX, USA
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Schuster KM, O'Connor R, Cripps M, Kuhlenschmidt K, Taveras L, Kaafarani HM, El Hechi M, Puri R, Mull J, Schroeppel TJ, Rodriquez J, Cullinane DC, Cullinane LM, Enniss TM, Sensenig R, Zilberman B, Crandall M. Multicenter validation of the American Association for the Surgery of Trauma grading scale for acute cholecystitis. J Trauma Acute Care Surg 2021; 90:87-96. [PMID: 33332782 DOI: 10.1097/ta.0000000000002901] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The American Association for the Surgery of Trauma (AAST) patient assessment committee has created grading systems for emergency general surgery diseases to assist with clinical decision making and risk adjustment during research. Single-institution studies have validated the cholecystitis grading system as associated with patient outcomes. Our aim was to validate the grading system in a multi-institutional fashion and compare it with the Parkland grade and Tokyo Guidelines for acute cholecystitis. METHODS Patients presenting with acute cholecystitis to 1 of 8 institutions were enrolled. Discrete data to assign the AAST grade were collected. The Parkland grade was collected prospectively from the operative surgeon from four institutions. Parkland grade, Tokyo Guidelines, AAST grade, and the AAST preoperative grade (clinical and imaging subscales) were compared using linear and logistic regression to the need for surgical "bailout" (subtotal or fenestrated cholecystectomy, or cholecystostomy), conversion to open, surgical complications (bile leak, surgical site infection, bile duct injury), all complications, and operative time. RESULTS Of 861 patients, 781 underwent cholecystectomy. Mean (SD) age was 51.1 (18.6), and 62.7% were female. There were six deaths. Median AAST grade was 2 (interquartile range [IQR], 1-2), and median Parkland grade was 3 (interquartile range [IQR], 2-4). Median AAST clinical and imaging grades were 2 (IQR, 2-2) and 1 (IQR, 0-1), respectively. Higher grades were associated with longer operative times, and worse outcomes although few were significant. The Parkland grade outperformed the AAST grade based on area under the receiver operating characteristic curve. CONCLUSION The AAST cholecystitis grading schema has modest discriminatory power similar to the Tokyo Guidelines, but generally lower than the Parkland grade, and should be modified before widespread use. LEVEL OF EVIDENCE Diagnostic study, level IV.
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Affiliation(s)
- Kevin M Schuster
- From the Department of Surgery (K.M.S., R.O.), Yale School of Medicine, New Haven, CT; Department of Surgery (M. Cripps, K.K., L.T.), University of Texas Southwestern School of Medicine, Dallas, TX; Department of Surgery (H.M.K., M.E.), Massachusetts General Hospital, Boston, MA; Department of Surgery (R.P., M. Crandall, J.M.), College of Medicine - Jacksonville, University of Florida, Jacksonville, FL; Department of Surgery (T.J.S., J.R.), UC Health, Colorado Springs, CO; Department of Surgery (D.C.C., L.M.C.), Marshfield Clinic, Marshfield, WI; Department of Surgery (T.M.E.), School of Medicine, University of Utah, Salt Lake City, UT; and Department of Surgery (R.S., B.Z.), Cooper Medical School of Rowan University, Camden, NJ
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Han IW, Lee HK, Park DJ, Choi YS, Lee SE, Kim H, Kwon W, Jang JY, Lee H, Heo JS. Long-term patient-reported outcomes following laparoscopic cholecystectomy: A prospective multicenter observational study. Medicine (Baltimore) 2020; 99:e21683. [PMID: 32871883 PMCID: PMC7458203 DOI: 10.1097/md.0000000000021683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Several studies have reported short-term results for post-cholecystectomy symptoms and quality of life (QoL). However, reports on long-term results are still limited. This study aimed to identify risk factors affecting short- and long-term patient-reported outcome (PRO) following laparoscopic cholecystectomy.From 2016 to 2017, a total of 476 patients from 5 institutions were enrolled. PRO was examined using the Numeric Rating Scale (NRS) pain score and the Gastrointestinal (GI) QoL Index questionnaire at postoperative 1 month and 1 year.Most of patients recovered well at postoperative 1 year compared to postoperative 1 month for the NRS pain score, QoL score, and GI symptoms. A high operative difficulty score (HR 1.740, P = .031) and pathology of acute or complicated cholecystitis (HR 1.524, P = .048) were identified as independent risk factors for high NRS pain scores at postoperative 1 month. Similarly, female sex (HR 1.571, P = .003) at postoperative 1 month and postoperative complications (HR 5.567, P = .001) at postoperative 1 year were independent risk factors for a low QoL. Also, age above 50 (HR 1.842, P = .001), female sex (HR 1.531, P = .006), and preoperative gallbladder drainage (HR 3.086, P = .001) were identified as independent risk factors for GI symptoms at postoperative 1 month.Most patients showed improved long-term PRO measurement in terms of pain, QoL, and GI symptoms. There were no independent risk factors for long-term postoperative pain and GI symptoms. However, postoperative complications were identified to affect QoL adversely at postoperative 1 year. Careful and long-term follow up is thus necessary for patients who experienced postoperative complications.
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Affiliation(s)
- In Woong Han
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon Kook Lee
- Department of Surgery, Ewha Womans University College of Medicine
| | - Dae Joon Park
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Yoo Shin Choi
- Department of Surgery, Chung-Ang University College of Medicine
| | - Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine
| | - Hongbeom Kim
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
- Department of Surgery, Dongguk University College of Medicine, Goyang, South Korea
| | - Wooil Kwon
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Jin-Young Jang
- Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul
| | - Huisong Lee
- Department of Surgery, Ewha Womans University College of Medicine
| | - Jin Seok Heo
- Division of Hepatobiliary-Pancreatic Surgery Departments of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Liu L, Yuan X, Yang L, Zhang J, Luo J, Huang G, Huo J. Effect of acupuncture on hormone level in patients with gastrointestinal dysfunction after general anesthesia: A study protocol for a randomized controlled trial. Medicine (Baltimore) 2020; 99:e19610. [PMID: 32243385 PMCID: PMC7440186 DOI: 10.1097/md.0000000000019610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Postoperative gastrointestinal dysfunction (PGD) refers to one of the common postoperative complications. Acupuncture can facilitate the recovery of PGD, whereas no therapeutic schedule of acupuncture has been internationally recognized for treating PGD. In the present study, a scientific trial protocol has been proposed to verify the feasibility of acupuncture in treating gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. We conduct this protocol to investigate whether acupuncture recovery gastrointestinal dysfunction by influencing the expression of gastrointestinal hormone. METHOD The present study refers to a randomized, evaluator blinded, controlled, multi-center clinical trial; it was designed complying with the Consolidated Standards of Reporting Trials (CONSORT 2010) as well as the Standard for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be taken from the inpatients having undergone laparoscopic surgery of Mianyang Affiliated Hospital of Chengdu University of traditional Chinese medicine, Mianyang Third Hospital and Mianyang Anzhou Hospital. Based on the random number yielded using SPSS 25.0 software, the qualified subjects will be randomly classified to the experimental group and the control group. Therapies will be performed 30 min once after operation, the experimental group will be treated with acupuncture, while the control group will receive intravenous injection of granisetron. The major outcome will be the time to first flatus, and the secondary outcomes will include the time to first defecation, abdominal pain, dosage of analgesia pump, abdominal distention, nausea, vomiting, gastrointestinal hormone, as well as mental state. The efficacy and safety of acupuncture will be also assessed following the principle of Good Clinical Practice (GCP). DISCUSS A standardized and scientific clinical trial is conducted to assess the efficacy and safety of acupuncture for gastrointestinal dysfunction after laparoscopic cholecystectomy under general anesthesia. The aim is to objectively evidence and improves the clinical practice of acupoint prescription, as an attempt to promote the clinical application of this technology.
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Affiliation(s)
- Lisha Liu
- Mianyang Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang
| | - Xiuli Yuan
- Mianyang Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang
| | - Lei Yang
- Mianyang Affiliated Hospital, Chengdu University of Traditional Chinese Medicine, Mianyang
| | - Jingyuan Zhang
- ChengDu University of Traditional Chinese Medicine, Chengdu
| | - Jing Luo
- Mianyang Third Hospital, Mianyang
| | | | - Jian Huo
- ChengDu University of Traditional Chinese Medicine, Chengdu
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Bicket MC, Grant MC, Scott MJ, Terman GW, Wick EC, Wu CL. AAAPT Diagnostic Criteria for Acute Abdominal and Peritoneal Pain After Surgery. THE JOURNAL OF PAIN 2020; 21:1125-1137. [PMID: 32006701 DOI: 10.1016/j.jpain.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/18/2019] [Accepted: 01/24/2020] [Indexed: 02/07/2023]
Abstract
Abdominal and peritoneal pain after surgery is common and burdensome, yet the lack of standardized diagnostic criteria for this type of acute pain impedes basic, translational, and clinical investigations. The collaborative effort among the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks, American Pain Society, and American Academy of Pain Medicine Pain Taxonomy (AAAPT) provides a systematic framework to classify acute painful conditions. Using this framework, a multidisciplinary working group reviewed the literature and developed core diagnostic criteria for acute abdominal and peritoneal pain after surgery. In this report, we apply the proposed AAAPT framework to 4 prototypical surgical procedures resulting in abdominal and peritoneal pain as examples: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection. These diagnostic criteria address the 3 most common surgical procedures performed in the United States, capture diverse surgical approaches, and may also be applied to other surgical procedures resulting in abdominal and peritoneal pain. Additional investigation regarding the validity and reliability of this framework will facilitate its adoption in research that advances our comprehension of mechanisms, deliver better treatments, and help prevent the transition of acute to chronic pain after surgery in the abdominal and peritoneal region. PERSPECTIVE: Using AAAPT, we present key diagnostic criteria for acute abdominal and peritoneal pain after surgery. We provide a systematic classification using 5 dimensions for abdominal and peritoneal pain that occurs after surgery, in addition to 4 specific surgical procedures: cesarean delivery, cholecystectomy, colorectal surgical procedures, and pancreas resection.
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Affiliation(s)
- Mark C Bicket
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Michael C Grant
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael J Scott
- Department of Anesthesiology, Virginia Commonwealth University; Richmond, Virginia
| | - Gregory W Terman
- Department of Anesthesiology, University of Washington, Seattle, Washington
| | - Elizabeth C Wick
- Department of Surgery; The University of California San Francisco, San Francisco, California
| | - Christopher L Wu
- Department of Anesthesiology, Critical Care & Pain Management; Hospital for Special Surgery, New York, New York; Department of Anesthesiology, Weill Cornell Medicine, New York, New York
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11
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Assessing long term quality of life in geriatric patients after elective laparoscopic cholecystectomy. Am J Surg 2019; 219:1039-1044. [PMID: 31526511 DOI: 10.1016/j.amjsurg.2019.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/06/2019] [Accepted: 08/24/2019] [Indexed: 01/11/2023]
Abstract
INTRODUCTION While cholecystectomy is shown to be safe in older patients, few existent studies investigate associated quality of life. This study examines quality of life in symptomatic geriatric patients after elective laparoscopic cholecystectomy. METHODS Patients ≥65 years of age who underwent elective laparoscopic cholecystectomy at a tertiary care center were administered the 12-Item Short Form Survey (SF-12) and a gastrointestinal survey pre-operatively and post-operatively (within 6 and 18 months of surgery). Quality of life characteristics were compared amongst visit type in univariate and multivariate settings, with a mixed-model regression. RESULTS Our sample included 30 patients. Pain frequency (p = 0.004) and pain severity (p = 0.013) scores improved with each subsequent visit type. SF-12 mental health aggregate score improved overall from pre-operative to long term follow-up (p = 0.0403). DISCUSSION Our findings suggest that health-related quality of life in geriatric patients improves after elective laparoscopic cholecystectomy in the short and long term. SUMMARY Quality of life was assessed in symptomatic geriatric patients undergoing elective laparoscopic cholecystectomy. Pain frequency, pain severity, and the SF-12 mental health aggregate scores improved overall from pre-operative to post-operative visit types.
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Latenstein CSS, Wennmacker SZ, de Jong JJ, van Laarhoven CJHM, Drenth JPH, de Reuver PR. Etiologies of Long-Term Postcholecystectomy Symptoms: A Systematic Review. Gastroenterol Res Pract 2019; 2019:4278373. [PMID: 31110517 PMCID: PMC6487117 DOI: 10.1155/2019/4278373] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 01/28/2019] [Accepted: 02/10/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Cholecystectomy does not relieve abdominal symptoms in up to 40% of patients. With 700,000 cholecystectomies performed in the US, annually, about 280,000 patients are left with symptoms, making this a serious problem. We performed a systematic review to determine the different etiologies of long-term postcholecystectomy symptoms with the aim to provide guidance for clinicians treating these patients. METHODS A systematic search of the literature was performed using MEDLINE, EMBASE, and Web of Science. Articles describing at least one possible etiology of long-term symptoms after a laparoscopic cholecystectomy were included in this review. Long-term symptoms were defined as abdominal symptoms that were present at least four weeks after cholecystectomy, either persistent or incident. The etiologies of persistent and incident symptoms after LC and the mechanism or hypothesis behind the etiologies are provided. If available, the prevalence of the discussed etiology is provided. RESULTS The search strategy identified 3320 articles of which 130 articles were included. Etiologies for persistent symptoms were residual and newly formed gallstones (41 studies, prevalence ranged from 0.2 to 23%), coexistent diseases (64 studies, prevalence 1-65%), and psychological distress (13 studies, no prevalence provided). Etiologies for incident symptoms were surgical complications (21 studies, prevalence 1-3%) and physiological changes (39 studies, prevalence 16-58%). Sphincter of Oddi dysfunction (SOD) was reported as an etiology for both persistent and incident symptoms (21 studies, prevalence 3-40%). CONCLUSION Long-term postcholecystectomy symptoms vary amongst patients, arise from different etiologies, and require specific diagnostic and treatment strategies. Most symptoms after cholecystectomy seem to be caused by coexistent diseases and physiological changes due to cholecystectomy. The outcome of this research is summarized in a decision tree to give clinical guidance on the treatment of patients with symptoms after cholecystectomy.
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Affiliation(s)
| | - Sarah Z. Wennmacker
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Judith J. de Jong
- Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, Netherlands
| | | | - Joost P. H. Drenth
- Department of Gastroenterology, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Philip R. de Reuver
- Department of Surgery, Radboud University Medical Centre, Nijmegen, Netherlands
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Yu H, Chan EEH, Lingam P, Lee J, Woon WWL, Low JK, Shelat VG. Index admission laparoscopic cholecystectomy for acute cholecystitis restores Gastrointestinal Quality of Life Index (GIQLI) score. Ann Hepatobiliary Pancreat Surg 2018; 22. [PMID: 29536057 PMCID: PMC5845612 DOI: 10.14701/ahbps.2018.22.1.58] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUNDS/AIMS Previous studies have evaluated quality of life (QoL) in patients who underwent laparoscopic cholecystectomy (LC) for cholelithiasis. The purpose of this study was to evaluate QoL after index admission LC in patients diagnosed with acute cholecystitis (AC) using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire. METHODS Patients ≥21 years admitted to Tan Tock Seng Hospital, Singapore for AC and who underwent index admission LC between February 2015 and January 2016 were evaluated using the GIQLI questionnaire preoperatively and 30 days postoperatively. RESULTS A total of 51 patients (26 males, 25 females) with a mean age of 60 years (24-86 years) were included. Median duration of abdominal pain at presentation was 2 days (1-21 days). 45% of patients had existing comorbidities, with diabetes mellitus being most common (33%). 31% were classified as mild AC, 59% as moderate and 10% as severe AC according to Tokyo Guideline 2013 (TG13) criteria. Post-operative complications were observed in 8 patients, including retained common bile duct stone (n=1), wound infection (n=2), bile leakage (n=2), intra-abdominal collection (n=1) and atrial fibrillation (n=2). 86% patients were well at 30 days follow-up and were discharged. A significant improvement in GIQLI score was observed postoperatively, with mean total GIQLI score increasing from 106.0±16.9 (101.7-112.1) to 120.4±18.0 (114.8-125.9) (p<0.001). Significant improvements were also observed in GIQLI subgroups of gastrointestinal symptoms, physical status, emotional status and social function status. CONCLUSIONS Index admission LC restores QoL in patients with AC as measured by GIQLI questionnaire.
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Affiliation(s)
- Hongyan Yu
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Pravin Lingam
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Jingwen Lee
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | | | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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Zhao W, Li J, Wang Y, Liu J, Chen Y, Zhao G, Zhao Y, Bu H, Tseng Y, Shi X. Efficacy and safety of the "Xingnao Kaiqiao" acupuncture technique via intradermal needling to treat postoperative gastrointestinal dysfunction of laparoscopic surgery: study protocol for a randomized controlled trial. Trials 2017; 18:567. [PMID: 29179761 PMCID: PMC5704354 DOI: 10.1186/s13063-017-2319-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 10/24/2017] [Indexed: 01/08/2023] Open
Abstract
Background Xingnao Kaiqiao acupuncture involves needling of the Neiguan (PC6), Renzhong (DU26), and Sanyinjiao (SP6) acupoints. The technique has a significant clinical effect in many neurological diseases. In the present report, we have developed a protocol for a scientific trial to analyze whether Xingnao Kaiqiao can be used to treat gastrointestinal dysfunction after laparoscopic surgery. In this context, we intend to execute a double-blind, randomized controlled trial to assess the efficacy and safety of Xingnao Kaiqiao acupuncture via intradermal needling. Methods/design This will be a single-center, double-blind, randomized controlled clinical trial. It has been designed on the basis of the Consolidated Standards of Reporting Trials (CONSORT 2010) guidelines and the Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICTA). The subjects will be recruited from among inpatients scheduled for laparoscopic surgery at the Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, China. Using random numbers generated in SPSS 19.0, the recruited subjects will be allocated to either the “Xingnao Kaiqiao” group or the sham stimulation group. A specially appointed investigator will be in charge of the randomization. Xingnao Kaiqiao via intradermal needling (or sham needling) will be administered 6 h after laparoscopic surgery, and then every 12 h for a total of six sessions, each of which will last 3 min. The subjects will undergo their first evaluation shortly before the first treatment (6 h after laparoscopic surgery); evaluations will be repeated every 12 h until a total of seven evaluations have been completed. The primary outcome will be the time until the first postoperative flatus. The secondary outcomes will be: the time until the first postoperative defecation; levels of abdominal pain, abdominal distension, and nausea; blood ghrelin level; occurrence of vomiting; psychological status; and quality of life. Discussion This upcoming randomized clinical trial was designed as a standardized method to assess the efficacy and safety of Xingnao Kaiqiao acupuncture using intradermal needles on PC6, DU26, and SP6 in the treatment of gastrointestinal dysfunction after laparoscopic surgery. We aim to provide evidence and thus improve the clinical application of this technique. Trial registration Chinese Clinical Trial Registry, ChiCTR-IOR-17010763. Registered on 2 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2319-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wenli Zhao
- Graduate School, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Department of Neurology, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Jinting Li
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Yuling Wang
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Jing Liu
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Ying Chen
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Guang Zhao
- Department of Minimally Invasive Surgery, Tianjin Nankai Hospital, Tianjin, 300100, China
| | - Ye Zhao
- Department of Chemical Engineering, University of Florida, Gainesville, Florida, 32611, USA
| | - Huaien Bu
- College of Traditional Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yiider Tseng
- Department of Chemical Engineering, University of Florida, 1006 Center Drive, Gainesville, Florida, 32611, USA.
| | - Xuemin Shi
- Department of Acupuncture, First Affiliated Hospital, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
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Mueck KM, Cherla DV, Taylor A, Ko TC, Liang MK, Kao LS. Randomized Controlled Trials Evaluating Patient-Reported Outcomes after Cholecystectomy: A Systematic Review. J Am Coll Surg 2017; 226:183-193.e5. [PMID: 29154921 DOI: 10.1016/j.jamcollsurg.2017.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 10/20/2017] [Accepted: 10/25/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Krislynn M Mueck
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX.
| | - Deepa V Cherla
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Amy Taylor
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Tien C Ko
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Mike K Liang
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
| | - Lillian S Kao
- Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX; Center for Surgical Trials and Evidence-based Practice (C-STEP), Departments of Surgery and Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX
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Talseth A, Edna TH, Hveem K, Lydersen S, Ness-Jensen E. Quality of life and psychological and gastrointestinal symptoms after cholecystectomy: a population-based cohort study. BMJ Open Gastroenterol 2017; 4:e000128. [PMID: 28761686 PMCID: PMC5508800 DOI: 10.1136/bmjgast-2016-000128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 01/10/2017] [Accepted: 01/22/2017] [Indexed: 01/01/2023] Open
Abstract
Objective The study aims to examine gastrointestinal symptoms, quality of life and the risk of psychological symptoms after cholecystectomy. Design This is a prospective population-based cohort study based on the Nord-Trøndelag Health Study (HUNT) Norway. HUNT is a repeated health survey of the county population and includes a wide range of health-related items. In the present study, all 3 HUNT surveys were included, performed between 1984 and 2008. Selected items were scores on quality of life, the Hospital Anxiety and Depression Scale (HADS) and selected gastrointestinal symptoms. Participants who underwent cholecystectomy for gallstone disease between 1 January 1990 and until 1 year before attending HUNT3 were compared with the remaining non-operated cohort. Associations between cholecystectomy and the postoperative scores and symptoms were assessed by multivariable regression models. Results Participants in HUNT1, HUNT2 and HUNT3 were 77 212 (89.4% of those invited), 65 237 (69.5%) and 50 807 (54.1%), respectively. In the study period, 931 participants were operated with cholecystectomy. Cholecystectomy was associated with an increased risk of diarrhoea and stomach pain postoperatively. In addition, cholecystectomy was associated with an increased risk of nausea postoperatively in men. We found no associations between cholecystectomy and quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation following surgery. Conclusions In this large population-based cohort study, cholecystectomy was associated with postoperative diarrhoea and stomach pain. Cholecystectomy for gallstone colic was associated with nausea in men. There were no associations between quality of life, symptoms of anxiety and depression, constipation, heartburn, or acid regurgitation.
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Affiliation(s)
- Arne Talseth
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Public Health and General Practice, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Tom-Harald Edna
- Department of Surgery, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Unit for Applied Clinical Research, Institute of Cancer Research and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Hveem
- Department of Public Health and General Practice, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
| | - Stian Lydersen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Institute of Neuroscience, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eivind Ness-Jensen
- Department of Public Health and General Practice, HUNT Research Centre, NTNU, Norwegian University of Science and Technology, Levanger, Norway
- Department of Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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Noel R, Arnelo U, Enochsson L, Lundell L, Nilsson M, Sandblom G. Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease. Scand J Gastroenterol 2016; 51:465-71. [PMID: 26784974 DOI: 10.3109/00365521.2015.1111935] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE There are considerable variations in cholecystectomy rates between countries, but it remains unsettled whether high cholecystectomy rates prevent future gallstone complications by reducing the gallstone prevalence. The aims of this study were to investigate the regional differences in cholecystectomy rates and their relation to the incidence of gallstone complications. MATERIAL AND METHODS Nation-wide registry-based study of the total number of cholecystectomies in Sweden between 1998 and 2013. Data were obtained from the Swedish Inpatient Registry covering the entire population and subdivided for by the 21 different counties. Indications for the procedure were prospectively collected during the years 2006-2013 in the National Registry for Gallstone Surgery and ERCP. The detailed demography of the total number of patients undergoing cholecystectomy and its relation to the respective indications were analysed by linear regression. RESULTS The annual rates of cholecystectomy in the Swedish counties ranged from 100 to 207 per 100,000 inhabitants, with a mean of 157 (95% CI 145-169). The majority of cholecystectomies were done in females based on the indication biliary colic, with a peak incidence in younger ages. Cholecystectomies performed due to gallstone complications, pancreatitis and cholecystitis, were mainly carried out in the older age groups. No significant relationship could be demonstrated between cholecystectomy rates in the different regions and the respective incidences of gallstone complications. CONCLUSIONS There are wide regional variations in cholecystectomy rates in Sweden. The present study does not give support that frequent use of cholecystectomy in uncomplicated gallstone disease prevents future gallstone complications.
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Affiliation(s)
- Rozh Noel
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
| | - Urban Arnelo
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
| | - Lars Enochsson
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
| | - Lars Lundell
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
| | - Magnus Nilsson
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
| | - Gabriel Sandblom
- a Center for Digestive Diseases, CLINTEC, Karolinska Institutet, Karolinska University Hospital and Division of Surgery , Stockholm , Sweden
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Does the Frequency of Cholecystectomy Affect the Ensuing Incidence of Gallbladder Cancer in Sweden? A Population-Based Study with a 16-Year Coverage. World J Surg 2016; 40:66-72. [PMID: 26470697 DOI: 10.1007/s00268-015-3267-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer (GBC) is rare among the different gastrointestinal cancers with a significant global variation in incidence. High cholecystectomy rates on benign indications have been assumed to prevent the development of gallbladder cancer. The aim of the present study was to explore the relationship between the rate of cholecystectomy at different time periods and regions of the country and the annual incidence of GBC. METHODS Standardized cholecystectomy and GBC incidences for Swedish counties have been obtained from the Swedish national inpatient and National Cancer registries for the years 1998–2013. The incidences have been calculated for ages over 15 years and per 100,000 population. The relationships between cholecystectomy and GBC incidences have been analyzed using regression models. Correlation analyses were performed for the total cumulative incidence rates as well as the incidence rates calculated for the first and last 8 years of the entire study period. RESULTS Cholecystectomy rates ranged from 99 to 205 per 100,000 and year, and the GBC incidence from 2.3 to 5.1. Overall, we observed a slow but steady decline in cholecystectomy rates—as well as GBC incidences during the 16-year period. No significant correlation between the cholecystectomy rates and GBC incidences was seen. CONCLUSIONS This nationwide population-based study demonstrates substantial geographic differences in annual cholecystectomy rates without any significant inverse co-variation between cholecystectomy rates and the ensuing GBC incidence which would have supported the idea that frequent cholecystectomy affects the incidence of GBC.
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How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population? World J Surg 2016; 40:81-8. [PMID: 26319262 DOI: 10.1007/s00268-015-3240-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Previous studies have indicated a correlation between indication for cholecystectomy and long-term gastrointestinal quality-of-life (QoL). The aim of the present study was to compare QoL in a post-cholecystectomy cohort with the background population and with historical controls. METHODS A post-cholecystectomy study group (on average 4 years after cholecystectomy) was compared with a control group from the background population using the Gastrointestinal Quality-of-Life Index (GIQLI). EQ-5D scores were compared with expected scores derived from recent historical data. RESULTS The post-cholecystectomy study group (N = 451) had better QoL measured by the EQ-5D compared with historical controls (p < 0.001), similar total GIQLI scores as the control group (N = 390), but scored worse on the GIQLI gastrointestinal symptoms subscale score (p < 0.001). The results include an item-by-item breakdown of the GIQLI questionnaire where the scores for diarrhea, bowel urgency, bloating, regurgitation, abdominal pain, flatus, fullness, nausea, uncontrolled stools, belching, heartburn, restricted eating, and bowel frequency were found to be significantly lower (i.e. worse) in the post-cholecystectomy cohort than in the control group. The opposite was true for relationships, endurance, sexual life, physical strength, feeling fit, not being frustrated by illness, and being able to carry out leisure activities, i.e. items related to general performance and well-being. CONCLUSIONS In this study, QoL after cholecystectomy was good, but there was an increased prevalence of gastrointestinal symptoms compared to the background population.
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Qiu WQ, Jiang JY. Effect of acupoint injection of Neostigmine on gastrointestinal function after cholecystectomy. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2015. [DOI: 10.1007/s11726-015-0884-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Vartolomei MD, Kiss B, Vidal A, Burkhard F, Thalmann GN, Roth B. Long-term results of a prospective randomized trial assessing the impact of re-adaptation of the dorsolateral peritoneal layer after extended pelvic lymph node dissection and cystectomy. BJU Int 2015; 117:618-28. [PMID: 25959738 DOI: 10.1111/bju.13178] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the long-term oncological and functional outcomes of re-adaptation of the dorsolateral peritoneal layer after pelvic lymph node dissection (PLND) and cystectomy. PATIENTS AND METHODS A randomized, single-centre, single-blinded, two-arm trial was conducted on 200 consecutive patients who underwent PLND and cystectomy for bladder cancer (<cT4, cN0, cM0) between April 2006 and September 2009. Patients were randomized into two groups: group A with re-adaptation of the dorsolateral peritoneal layer (n = 100; 73 male, 27 female; median [range] age 68 [35-86] years) and group B without re-adapation (n = 100; 66 male, 34 female; median [range] age 65 [30-86] years). Regular postoperative follow-up was performed at our outpatient clinic. The median follow-up was 59 (3-100) months. Five patients were lost to follow-up in group A and seven in group B. Bowel function was evaluated using the validated Gastrointestinal Quality of Life Index questionnaire and an institutional questionnaire regarding post-cystectomy outcome. Local recurrences and distal metastases were evaluated using computed tomography and bone scan at the regular follow-up visits. RESULTS There was no significant difference between the two groups in terms of the rate of local (pelvic) recurrence (5/95 [5.3%] in group A; 7/93 [7.5%] in group B; P = 0.53), the rate of distant metastases (21/95 [22.1%] in group A; 23/93 [24.7%] in group B; P = 0.67), cancer-specific survival (P = 0.37) or overall survival (P = 0.59). Group A had significantly better bowel function at 3 (P < 0.001), 6 (P < 0.006), 12 (P < 0.006) and 24 months (P = 0.04), and significantly less postoperative abdominal pain and bloating at 3 (P = 0.002) and 6 months (P = 0.01). CONCLUSION Re-adaptation of the dorsolateral peritoneal layer after PLND and cystectomy has a beneficial long-term impact on bowel function and postoperative pain without compromising oncological radicality.
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Affiliation(s)
- Mihai Dorin Vartolomei
- Department of Urology, University of Bern, Bern, Switzerland.,Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Bernhard Kiss
- Department of Urology, University of Bern, Bern, Switzerland
| | - Alvaro Vidal
- Department of Urology, University of Bern, Bern, Switzerland
| | - Fiona Burkhard
- Department of Urology, University of Bern, Bern, Switzerland
| | | | - Beat Roth
- Department of Urology, University of Bern, Bern, Switzerland
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