Brief Article
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World J Gastroenterol. Mar 28, 2012; 18(12): 1365-1372
Published online Mar 28, 2012. doi: 10.3748/wjg.v18.i12.1365
Post-cholecystectomy symptoms were caused by persistence of a functional gastrointestinal disorder
Malte Schmidt, Karl Søndenaa, John A Dumot, Steven Rosenblatt, Trygve Hausken, Maria Ramnefjell, Gro Njølstad, Geir Egil Eide
Malte Schmidt, Karl Søndenaa, Department of Surgery, Haraldsplass Deaconess Hospital, Bergen N-5892, Norway
Malte Schmidt, Karl Søndenaa, Department of Surgical Sciences, University of Bergen, Bergen 5021, Norway
John A Dumot, Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44101, United States
Steven Rosenblatt, Department of General Surgery, Cleveland Clinic, Cleveland, OH 44101, United States
Trygve Hausken, Department of Internal Medicine, University of Bergen, Bergen 5021, Norway
Maria Ramnefjell, Department of Pathology, Haukeland University Hospital, Bergen 5021, Norway
Gro Njølstad, Department of Microbiology, Haukeland University Hospital, Bergen 5021, Norway
Geir Egil Eide, Center for Clinical Research, Haukeland University Hospital, Bergen 5021, Norway
Geir Egil Eide, Department of Public Health and Primary Care, University of Bergen, Bergen 5021, Norway
Author contributions: Schmidt M wrote the article and analysed statistical data together with Eide GE; Søndenaa K designed study, operated patients and collected study material; Dumot JA translated study form and collected data; Rosenblatt S operated patients and collected data; Hausken T analysed data collected from study forms; Ramnefjell M did the histology of removed gallbladders, and Njølstad G did the bacterial analyses.
Supported by The Western Norway Health Trust, the University of Bergen, and Haraldsplass Deaconess Hospital
Correspondence to: Karl Søndenaa, Professor, MD, PhD, Department of Surgery, Haraldsplass Deaconess Hospital, University of Bergen, POB 6165, Bergen N-5892, Norway. kasoende@online.no
Telephone: +47-91868877 Fax: +47-55978555
Received: May 28, 2011
Revised: July 14, 2011
Accepted: July 21, 2011
Published online: March 28, 2012
Abstract

AIM: To classify gallstone disease as a basis for assessment of post-cholecystectomy symptoms.

METHODS: One hundred and fifty three patients with a clinical and ultrasonographic diagnosis of gallstones filled out a structured questionnaire on abdominal pain symptoms and functional gastrointestinal disorder (FGID) before and at six months after cholecystectomy. Symptom frequency groups (SFG) were categorized according to frequency of pain attacks. According to certain pain characteristics in gallstone patients, a gallstone symptom score was accorded on a scale from one to ten. A visual analogue scale was used to quantify pain. Operative specimens were examined for size and magnitude of stone contents as well as presence of bacteria. Follow-up took place after six months with either a consultation or via a mailed questionnaire. Results were compared with those obtained pre-operatively to describe and analyze symptomatic outcome.

RESULTS: SFG groups were categorized as severe (24.2%), moderate (38.6%), and mild (22.2%) attack frequency, and a chronic pain condition (15%). Pain was cured or improved in about 90% of patients and two-thirds of patients obtained complete symptom relief. Patients with the most frequent pain episodes were less likely to obtain symptom relief. FGID was present in 88% of patients pre-operatively and in 57% post-operatively (P = 0.244). Those that became asymptomatic or improved with regard to pain also had most relief from FGID (P = 0.001). No pre-operative FGID meant almost complete cure.

CONCLUSION: Only one third of patients with FGID experienced postoperative relief, indicating that FGID was a dominant cause of post-cholecystectomy symptoms.

Keywords: Gallstone symptoms; Functional gastrointestinal disease; Cholecystectomy; Post-cholecystectomy symptoms