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RMJ. 2009; 34(2): 141-144

Influence of cholecystectomy on symptomatic cholelithiasis: can all symptoms be improved?

Mohammed Amir, Mohammad Zubair.

To analyze the outcome of cholecystectomies in patients with symptomatic cholelithiasis
for improvement in the pre-operative symptoms.
This cross-sectional interview-based prospective study included 200 patients who
responded to a pre-designed questionnaire in a tertiary care hospital, seen from March
2007 through May 2009. They were interviewed in the post-operative period for
improvement in their symptoms at intervals of 1, 3 and 6 months. The patients with
common bile duct stones, bilio-enteric fistulae, carcinoma of gall bladder with
cholelithiasis, and those lost to follow up were excluded from the study. A benefit ratio
(BR) was calculated using SPSS v. 13 for each symptom. BR close to 1.0 was interpreted
as evidence of gall stone disease related specifically to the symptom.
Out of 200 patients, there were 142 females and 58 males. Mean age was 46.5 years
(range 14-92, SD±14.25). 98.5% of patients had abdominal pain associated with
gallstones. Other symptoms of variable frequency were nausea (70%), dyspepsia
(58.5%), fatty food intolerance (57%), vomiting (25%), heartburn (24.5%) and flatulence
(21%). After cholecystectomy, 98.5% patients had complete relief of abdominal pain and
vomiting at 6 months (BR=1). Fatty food intolerance seen in 57% patients preoperatively
stayed at 7.5% at six months (BR=0.87). Dyspepsia persisted in 38.5%
patients post-operatively (BR=0.34). De novo appearance of symptoms was noted in 5%
of patients. 93.5% patients were satisfied with the outcome of surgery.
Cholecystectomy appears to relieve specifically biliary pain, nausea, vomiting and fatty
food intolerance associated with gallstone disease. Other abdominal symptoms that are
non-specific like flatulence, dyspepsia and heartburn are only partly relieved. Despite the
persistence or appearance of new symptoms, most patients were satisfied with the
outcome of surgery. (Rawal Med J 2009;34: ).

Key words: Cholelithiasis, cholecystectomy, symptoms, outcome.

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