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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 1998 Jan;80(1):25–32.

Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up.

G P Gui 1, C V Cheruvu 1, N West 1, K Sivaniah 1, A G Fiennes 1
PMCID: PMC2502763  PMID: 9579123

Abstract

The expectation that cholecystectomy is effective treatment for symptomatic gallstones is not always achieved in surgical practice. The impact of cholecystectomy on the relief of gastrointestinal symptoms was evaluated in 92 patients followed up after surgery for a mean of 31.1 months (range 12-83 months). Abdominal pain continued to be present, or arose de novo, in 28 (30.4%) patients. Pain-free outcome after cholecystectomy was associated with a preoperative clinical diagnosis of biliary colic, fatty food intolerance, and a thick-walled gallbladder on ultrasound (P = 0.02). Logistic regression associated a thick-walled gallbladder, elevated gamma-glutamyl transpetidase, body mass index < 26, fat intolerance, and normal bowel habit with good postoperative results (P = 0.001). Application of each of these five factors to a clinical index failed to predict long-term pain-free outcome after cholecystectomy. Abdominal bloating (P = 0.03), dyspepsia (P < 0.001), heartburn (P < 0.007), fat intolerance (P < 0.001), nausea (P = 0.001) and vomiting (P < 0.001) were significantly improved after cholecystectomy, but diarrhoea, constipation and excessive flatus were not. Outcome benefit ratios confirmed that vomiting (0.96), nausea (0.87), dyspepsia (0.67), fat intolerance (0.57) and heartburn (0.51) were relieved by surgery. Cholecystectomy improved symptoms compared with a matched control group, suggesting that surgery remains the gold standard treatment of symptomatic gallstones.

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Selected References

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  1. Bates T., Ebbs S. R., Harrison M., A'Hern R. P. Influence of cholecystectomy on symptoms. Br J Surg. 1991 Aug;78(8):964–967. doi: 10.1002/bjs.1800780823. [DOI] [PubMed] [Google Scholar]
  2. Black N. A., Thompson E., Sanderson C. F. Symptoms and health status before and six weeks after open cholecystectomy: a European cohort study.ECHSS Group. European Collaborative Health Services Study Group. Gut. 1994 Sep;35(9):1301–1305. doi: 10.1136/gut.35.9.1301. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Brown T. H., Walton G., Cheadle W. G., Larson G. M. The alkaline shift in gastric pH after cholecystectomy. Am J Surg. 1989 Jan;157(1):58–65. doi: 10.1016/0002-9610(89)90420-0. [DOI] [PubMed] [Google Scholar]
  4. Capper W. M., Butler T. J., Kilby J. O., Gibson M. J. Gallstones, gastric secretion, and flatulent dyspepsia. Lancet. 1967 Feb 25;1(7487):413–415. doi: 10.1016/s0140-6736(67)91176-2. [DOI] [PubMed] [Google Scholar]
  5. FRENCH E. B., ROBB W. A. Biliary and renal colic. Br Med J. 1963 Jul 20;2(5350):135–138. doi: 10.1136/bmj.2.5350.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fenster L. F., Lonborg R., Thirlby R. C., Traverso L. W. What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg. 1995 May;169(5):533–538. doi: 10.1016/S0002-9610(99)80212-8. [DOI] [PubMed] [Google Scholar]
  7. Gadacz T. R., Zuidema G. D. Bile acid composition in patients with and without symptoms of postoperative refulx gastritis. Am J Surg. 1978 Jan;135(1):48–52. doi: 10.1016/0002-9610(78)90008-9. [DOI] [PubMed] [Google Scholar]
  8. Gilliland T. M., Traverso L. W. Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. Surg Gynecol Obstet. 1990 Jan;170(1):39–44. [PubMed] [Google Scholar]
  9. Gunn A., Keddie N. Some clinical observations on patients with gallstones. Lancet. 1972 Aug 5;2(7771):239–241. doi: 10.1016/s0140-6736(72)91683-2. [DOI] [PubMed] [Google Scholar]
  10. Jazrawi S., Walsh T. N., Byrne P. J., Hill A. D., Li H., Lawlor P., Hennessy T. P. Cholecystectomy and oesophageal reflux: a prospective evaluation. Br J Surg. 1993 Jan;80(1):50–53. doi: 10.1002/bjs.1800800119. [DOI] [PubMed] [Google Scholar]
  11. Jones R. H., Lydeard S. E., Hobbs F. D., Kenkre J. E., Williams E. I., Jones S. J., Repper J. A., Caldow J. L., Dunwoodie W. M., Bottomley J. M. Dyspepsia in England and Scotland. Gut. 1990 Apr;31(4):401–405. doi: 10.1136/gut.31.4.401. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Kingston R. D., Windsor C. W. Flatulent dyspepsia in patients with gallstones undergoing cholecystectomy. Br J Surg. 1975 Mar;62(3):231–233. doi: 10.1002/bjs.1800620314. [DOI] [PubMed] [Google Scholar]
  13. Konsten J., Gouma D. J., von Meyenfeldt M. F., Menheere P. Long-term follow-up after open cholecystectomy. Br J Surg. 1993 Jan;80(1):100–102. doi: 10.1002/bjs.1800800132. [DOI] [PubMed] [Google Scholar]
  14. Legorreta A. P., Silber J. H., Costantino G. N., Kobylinski R. W., Zatz S. L. Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. JAMA. 1993 Sep 22;270(12):1429–1432. [PubMed] [Google Scholar]
  15. McMahon A. J., Ross S., Baxter J. N., Russell I. T., Anderson J. R., Morran C. G., Sunderland G. T., Galloway D. J., O'Dwyer P. J. Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: a randomized trial. Br J Surg. 1995 Oct;82(10):1378–1382. doi: 10.1002/bjs.1800821028. [DOI] [PubMed] [Google Scholar]
  16. Mort E. A., Guadagnoli E., Schroeder S. A., Greenfield S., Mulley A. G., McNeil B. J., Cleary P. D. The influence of age on clinical and patient-reported outcomes after cholecystectomy. J Gen Intern Med. 1994 Feb;9(2):61–65. doi: 10.1007/BF02600200. [DOI] [PubMed] [Google Scholar]
  17. Orlando R., 3rd, Russell J. C., Lynch J., Mattie A. Laparoscopic cholecystectomy. A statewide experience. The Connecticut Laparoscopic Cholecystectomy Registry. Arch Surg. 1993 May;128(5):494–499. doi: 10.1001/archsurg.1993.01420170024002. [DOI] [PubMed] [Google Scholar]
  18. Ros E., Zambon D. Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. Gut. 1987 Nov;28(11):1500–1504. doi: 10.1136/gut.28.11.1500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Ruddell W. S., Lintott D. J., Ashton M. G., Axon A. T. Endoscopic retrograde cholangiography and pancreatography in investigation of post-cholecystectomy patients. Lancet. 1980 Mar 1;1(8166):444–447. doi: 10.1016/s0140-6736(80)90996-4. [DOI] [PubMed] [Google Scholar]
  20. Scott E. A., Black N. Appropriateness of cholecystectomy in the United Kingdom--a consensus panel approach. Gut. 1991 Sep;32(9):1066–1070. doi: 10.1136/gut.32.9.1066. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Scott E. A., Black N. Appropriateness of cholecystectomy: the public and private sectors compared. Ann R Coll Surg Engl. 1992 Jul;74(4 Suppl):97–101. [PubMed] [Google Scholar]
  22. Scriven M. W., Burgess N. A., Edwards E. A., Morgan A. R., Bundred N. J., Lewis M. H. Cholecystectomy: a study of patient satisfaction. J R Coll Surg Edinb. 1993 Apr;38(2):79–81. [PubMed] [Google Scholar]
  23. Stefanini P., Carboni M., Patrassi N., Loriga P., De Bernardinis G., Negro P. Factors influencing the long term results of cholecystectomy. Surg Gynecol Obstet. 1974 Nov;139(5):734–738. [PubMed] [Google Scholar]
  24. Steiner C. A., Bass E. B., Talamini M. A., Pitt H. A., Steinberg E. P. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland. N Engl J Med. 1994 Feb 10;330(6):403–408. doi: 10.1056/NEJM199402103300607. [DOI] [PubMed] [Google Scholar]
  25. Talley N. J., McNeil D., Piper D. W. Discriminant value of dyspeptic symptoms: a study of the clinical presentation of 221 patients with dyspepsia of unknown cause, peptic ulceration, and cholelithiasis. Gut. 1987 Jan;28(1):40–46. doi: 10.1136/gut.28.1.40. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Thaysen E. H., Pedersen L. Idiopathic bile acid catharsis. Gut. 1976 Dec;17(12):965–970. doi: 10.1136/gut.17.12.965. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Vander Velpen G. C., Shimi S. M., Cuschieri A. Outcome after cholecystectomy for symptomatic gall stone disease and effect of surgical access: laparoscopic v open approach. Gut. 1993 Oct;34(10):1448–1451. doi: 10.1136/gut.34.10.1448. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Wilson R. G., Macintyre I. M. Symptomatic outcome after laparoscopic cholecystectomy. Br J Surg. 1993 Apr;80(4):439–441. doi: 10.1002/bjs.1800800410. [DOI] [PubMed] [Google Scholar]

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