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Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass
Örebro University, School of Medical Sciences.ORCID iD: 0000-0001-9521-1203
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Cholecystectomy (removal of the gallbladder) is standard surgical treatment for patients with symptomatic gallstone disease, albeit not without complications. Assessing the impact on quality of life is crucial for appropriate cholecystectomy patient selection, and the Gastrointestinal Quality of Life Index (GIQLI) is a 36-item questionnaire validated for this purpose.

Obesity and gastric bypass surgery each entail an increased risk of cholecystectomy, but the baseline cholecystectomy incidence in the obese population undergoing gastric bypass is unknown. Furthermore, the complication rate for cholecystectomy after gastric bypass has only been sparsely studied.

In Study I, GIQLI outcome in a post-cholecystectomy cohort of 451 patients from Mora County Hospital, Sweden, was explored. The primary cholecystectomy indication, together with sex, was found to predict gastrointestinal symptoms and abdominal pain after cholecystectomy.

In Study II, the GIQLI scores in the post-cholecystectomy cohort of Study I were compared with an age- and sex-matched control group of 390 individuals from the background population. The postcholecystectomy cohort stated significantly more gastrointestinal symptoms, especially symptoms related to bowel function such as diarrhoea, bowel urgency and bloating.

Study III was based on a cross-matching of the Swedish cholecystectomy register (GallRiks) with the Scandinavian obesity surgery register (SOReg). Previous gastric bypass doubled the postoperative complication rate after cholecystectomy and nearly quadrupled the reoperation rate. Compared with population data from the National Patient Register (NPR), the cholecystectomy incidence was substantially elevated already before gastric bypass and increased during month 6-36 thereafter.

In Study IV, the cross-matched GallRiks-SOReg database from Study III was used to compare aggregate complication rates for cholecystectomy and gastric bypass depending on the order of the two procedures. There was a significantly lower aggregate complication rate if cholecystectomy was performed before gastric bypass rather than after.

Place, publisher, year, edition, pages
Örebro: Örebro University , 2017. , p. 99
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 165
Keywords [en]
cholecystectomy, gastric bypass, bariatric, obesity, incidence, complications, register, gastrointestinal symptoms
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-59085ISBN: 978-91-7529-205-2 (print)OAI: oai:DiVA.org:oru-59085DiVA, id: diva2:1131250
Public defence
2017-10-06, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-08-14 Created: 2017-08-14 Last updated: 2017-09-08Bibliographically approved
List of papers
1. Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain
Open this publication in new window or tab >>Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain
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2014 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, no 12, p. 3075-3081Article in journal (Refereed) Published
Abstract [en]

Background: Despite the fact that cholecystectomy is a common surgical procedure, the impact on long-term gastrointestinal quality of life is not fully known.

Methods: All surgical procedures for gallstone disease performed at Mora County Hospital, Sweden, between 2 January 2002 and 2 January 2005, were registered on a standard database form. In 2007, all patients under the age of 80 years at follow-up were requested to fill in a form containing the Gastrointestinal Quality-of-Life Index (GIQLI) questionnaire and a number of additional questions. The outcome was analysed with respect to age, gender, smoking, surgical technique, and original indication for cholecystectomy.

Results: A total of 627 patients (447 women, 180 men) underwent cholecystectomy, including laparoscopic cholecystectomy (N = 524), laparoscopic cholecystectomy converted to open cholecystectomy (N = 43), and open cholecystectomy (N = 60). The mean time between cholecystectomy and follow-up with the questionnaire was 49 months. The participation rate was 79 %. Using multivariate analysis in the form of generalised linear modelling, the original indication for cholecystectomy in combination with gender (p = 0.0042) was found to predict the GIQLI score. Female gender in combination with biliary colic as indication for cholecystectomy correlated with low GIQLI scores. Female gender also correlated with a higher risk for pain in the right upper abdominal quadrant after cholecystectomy (p = 0.028).

Conclusions: We found the original indication for cholecystectomy, together with gender, to predict gastrointestinal symptoms and abdominal pain after cholecystectomy. Careful evaluation of symptoms is important before planning elective cholecystectomy.

Place, publisher, year, edition, pages
New York, USA: Springer-Verlag New York, 2014
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-47716 (URN)10.1007/s00268-014-2736-3 (DOI)000345103900009 ()25189441 (PubMedID)2-s2.0-84921047056 (Scopus ID)
Available from: 2016-01-21 Created: 2016-01-21 Last updated: 2017-11-30Bibliographically approved
2. How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?
Open this publication in new window or tab >>How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?
2016 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 40, no 1, p. 81-88Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
New York, USA: Springer-Verlag New York, 2016
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-47717 (URN)10.1007/s00268-015-3240-0 (DOI)000367465500011 ()26319262 (PubMedID)
Note

Funding Agency:

CKF Dalarna (Center for Clinical Research Dalarna)

Available from: 2016-01-21 Created: 2016-01-21 Last updated: 2017-11-30Bibliographically approved
3. Cholecystectomy after gastric bypass-incidence and complications
Open this publication in new window or tab >>Cholecystectomy after gastric bypass-incidence and complications
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2017 (English)In: Surgery for Obesity and Related Diseases, ISSN 1550-7289, E-ISSN 1878-7533, Vol. 13, no 6, p. 979-987Article in journal (Refereed) Published
Abstract [en]

Background: Although cholecystectomy incidence is known to be high after Roux-en-Y gastric bypass (RYGB) surgery, the actual increase in incidence is not known. Furthermore, the outcome of cholecystectomy after RYGB is not known.

Objectives: To estimate cholecystectomy incidence before and after RYGB and to compare the outcome of post-RYGB cholecystectomy with the cholecystectomy outcome in the background population.

Setting: Nationwide Swedish multiregister study.

Methods: The Swedish Register for Cholecystectomy and Endoscopic Retrograde Cholangiopancreatography (n = 79,386) and the Scandinavian Obesity Surgery Registry (n = 36,098) were cross-matched for the years 2007 through 2013 and compared with the National Patient Register.

Results: The standardized incidence ratio for cholecystectomy before RYGB was 3.42 (2.75-4.26, P < .001); the ratio peaked at 11.4 (10.2-12.6, P < .001) 6-12 months after RYGB, which was 3.54 times the baseline level (2.78-4.49, P < .001). After 36 months, the incidence ratio had returned to baseline. The post-RYGB group demonstrated an increased risk of 30-day postoperative complications after cholecystectomy (odds ratio 2.13, 1.78-2.56; P < .001), including reoperation (odds ratio 3.84, 2.76-5.36; P < .001), compared with the background population. The post-RYGB group also demonstrated a higher risk of conversion, acute cholecystectomy, and complicated gallstone disease and a slightly prolonged operative time, adjusted for age, sex, American Society of Anesthesiologists class, and previous open RYGB.

Conclusion: Compared with the background population, the incidence of cholecystectomy was substantially elevated already before RYGB and increased further 6-36 months after RYGB. Previous RYGB doubled the risk of postoperative complications after cholecystectomy and almost quadrupled the risk of reoperation, even when intraoperative cholangiography was normal. (C) 2017 American Society for Metabolic and Bariatric Surgery.

Place, publisher, year, edition, pages
New York: Elsevier, 2017
Keywords
Obesity, Gallstone, Cholecystectomy, Gastric bypass, Bariatric surgery
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-59318 (URN)10.1016/j.soard.2016.12.004 (DOI)000406080500014 ()28185764 (PubMedID)2-s2.0-85011573631 (Scopus ID)
Note

Funding Agencies:

Örebro University Research Committee  OLL-488991 

Olle Engqvist Research Foundation 

Available from: 2017-08-25 Created: 2017-08-25 Last updated: 2018-08-05Bibliographically approved
4. Morbidity of cholecystectomy and gastric bypass in a national database
Open this publication in new window or tab >>Morbidity of cholecystectomy and gastric bypass in a national database
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(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-60674 (URN)
Available from: 2017-09-08 Created: 2017-09-08 Last updated: 2017-09-08Bibliographically approved

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Wanjura, Viktor

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