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Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain
Department of Surgery, Örebro University Hospital, Örebro, Sweden.
Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.
Department of Surgery, Mora Hospital, Mora, Sweden.
Department of Surgery, Falun County Hospital, Falun, Sweden.
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2014 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 38, no 12, 3075-3081 p.Article 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. Vol. 38, no 12, 3075-3081 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-47716DOI: 10.1007/s00268-014-2736-3ISI: 000345103900009PubMedID: 25189441Scopus ID: 2-s2.0-84921047056OAI: oai:DiVA.org:oru-47716DiVA: diva2:896442
Available from: 2016-01-21 Created: 2016-01-21 Last updated: 2017-09-08Bibliographically 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. 99 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 165
Keyword
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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