Episodic Abdominal Pain Characteristics Are Not Associated with Clinically Relevant Improvement of Health Status After Cholecystectomy

An examination of rectal prolapse surgery patients' quality of life and symptoms using patient-reported outcome instruments: A prospective cohort study

BACKGROUND

We measured changes in self-reported health and symptoms attributable to rectal prolapse surgery using patient-reported outcome (PRO) measures.

METHODS

A prospectively recruited cohort of patients scheduled for rectal prolapse repair in Vancouver, Canada between 2013 and 2021 were surveyed before and 6-months after surgery using seven PROs: the EuroQol Five-Dimension Instrument (EQ-5D-5L), Generalized Anxiety Disorder Scale (GAD-7), Pain Intensity, Interference with Enjoyment of Life and General Activity (PEG), Patient Health Questionnaire (PHQ-9), Fecal Incontinence Severity Index (FISI), Gastrointestinal Quality of Life Index (GIQLI), and the Fecal Incontinence Quality of Life Scale (FIQL).

RESULTS

We included 46 participants who reported improvements in health status (EQ-5D-5L; p ​< ​0.01), pain interference (PEG; p ​< ​0.01), depressive symptoms (PHQ-9; p ​= ​0.01), fecal incontinence severity (FISI; p ​< ​0.01), gastrointestinal quality of life (GIQLI; p ​< ​0.01), and fecal incontinence quality of life (FIQL) related to lifestyle (p ​= ​0.02), coping and behaviour (p ​= ​0.02) and depression and self-perception (p ​= ​0.01).

CONCLUSION

Surgical repair of rectal prolapse improved patients' quality of life with meaningful improvements in fecal incontinence severity and pain, and symptom interference with daily activities.

Indications of cholecystectomy in gallstone disease

PURPOSE OF REVIEW

Recent studies showed new insights in the indication and timing of cholecystectomy in gallstone disease. This review will provide an overview.

RECENT FINDINGS

Considerable variations in indication for gallbladder surgery have been noticed leading to a significant number of unnecessary cholecystectomies. As a consequence, up to 33% of patients with uncomplicated symptomatic gallstone disease have persistent abdominal pain after cholecystectomy. On the other hand, studies showed that certain patients with acute cholecystitis, common bile duct stones and biliary pancreatitis benefit from same admission instead of delayed cholecystectomy.

SUMMARY

A critical view on indications for cholecystectomy in patients with uncomplicated symptomatic gallstone disease prevents unnecessary cholecystectomies. In patients with mild-to-moderate complicated symptomatic gallstone disease, same-admission cholecystectomy reduces the risk of recurrent complications.

Index admission laparoscopic cholecystectomy for acute cholecystitis restores Gastrointestinal Quality of Life Index (GIQLI) score

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.