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How Do Quality-of-Life and Gastrointestinal Symptoms Differ Between Post-cholecystectomy Patients and the Background Population?
Örebro University, School of Medical Sciences. Department of Surgery.
Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
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. Vol. 40, no 1, p. 81-88
National Category
Surgery
Research subject
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-47717DOI: 10.1007/s00268-015-3240-0ISI: 000367465500011PubMedID: 26319262OAI: oai:DiVA.org:oru-47717DiVA, id: diva2:896441
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
In thesis
1. Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass
Open this publication in new window or tab >>Register-based studies on cholecystectomy: Quality of life after cholecystectomy, and cholecystectomy incidence and complications after gastric bypass
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
cholecystectomy, gastric bypass, bariatric, obesity, incidence, complications, register, gastrointestinal symptoms
National Category
Surgery
Research subject
Surgery
Identifiers
urn:nbn:se:oru:diva-59085 (URN)978-91-7529-205-2 (ISBN)
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

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