Top

Published in:

01-03-2013 | Review

Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness

Authors: Mark P. Lamberts, Marjolein Lugtenberg, Maroeska M. Rovers, Anne J. Roukema, Joost P. H. Drenth, Gert P. Westert, Cornelis J. H. M. van Laarhoven

Published in: Surgical Endoscopy | Issue 3/2013

Abstract

Background

Cholecystectomy is the preferred treatment option for symptomatic gallstones, but the exact relationship between cholecystectomies and symptoms still is unclear. This study aimed to assess the effectiveness of elective cholecystectomy for patients with cholecystolithiasis in terms of both persistent and de novo symptoms.

Methods

A systematic literature search was conducted in Pubmed and Embase. The search included studies comprising patients 18 years of age or older undergoing elective cholecystectomy for symptomatic cholecystolithiasis. The proportions of symptoms after cholecystectomy were calculated and then subdivided into persistent and de novo symptoms.

Results

A total of 38 studies reported the presence of postcholecystectomy symptoms. The results showed that upper abdominal pain, the main indication for cholecystectomy in the majority of the patients, mostly disappeared after surgery. However, it persisted in up to 33 % of the patients and arose de novo in up to 14 %. Diarrhea (85 %) and constipation (76 %) were the persistent symptoms most often reported, whereas upper abdominal pain and vomiting were the least often reported. Flatulence (62 %) was the most often reported new symptom. However, large variations in symptoms were found between studies.

Conclusions

The review indicates that cholecystectomy often is ineffective with regard to persistent and de novo symptoms. The finding that the types and proportions of persistent symptoms differ from those that arise de novo suggests that this distinction may be useful in predicting which patients would and which would not benefit from a cholecystectomy.

Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States part III: liver, biliary tract, and pancreas. Gastroenterology 136:1134–1144PubMedCrossRef

Shaffer EA (2006) Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol 20:981–996PubMedCrossRef

Halldestam I, Enell EL, Kullman E, Borch K (2004) Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg 91:734–738PubMedCrossRef

Heaton KW, Braddon FE, Mountford RA, Hughes AO, Emmett PM (1991) Symptomatic and silent gallstones in the community. Gut 32:316–320PubMedCrossRef

Wittenburg H (2010) Hereditary liver disease: gallstones. Best Pract Res Clin Gastroenterol 24:747–756PubMedCrossRef

Everhart JE, Ruhl CE (2009) Burden of digestive diseases in the United States part I: overall and upper gastrointestinal diseases. Gastroenterology 136:376–386PubMedCrossRef

Ros E, Zambon D (1987) Postcholecystectomy symptoms: a prospective study of gallstone patients before and two years after surgery. Gut 28:1500–1504PubMedCrossRef

Finan KR, Leeth RR, Whitley BM, Klapow JC, Hawn MT (2006) Improvement in gastrointestinal symptoms and quality of life after cholecystectomy. Am J Surg 192:196–202PubMedCrossRef

Weinert CR, Arnett D, Jacobs D Jr, Kane RL (2000) Relationship between persistence of abdominal symptoms and successful outcome after cholecystectomy. Arch Intern Med 160:989–995PubMedCrossRef

10.

Berger MY, Hartman TCO, van der Velden JJ, Bohnen AM (2004) Is biliary pain exclusively related to gallbladder stones? A controlled prospective study. Br J Gen Pract 54:574–579PubMed

11.

Wallander MA, Johansson S, Ruigomez A, Garcia Rodriguez LA, Jones R (2007) Dyspepsia in general practice: incidence, risk factors, comorbidity, and mortality. Fam Pract 24:403–411PubMedCrossRef

12.

Fort JM, Azpiroz F, Casellas F, Andreu J, Malagelada JR (1996) Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology 111:617–622PubMedCrossRef

13.

Berger MY, Hartman TCO, Bohnen AM (2003) Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc 17:1723–1728PubMedCrossRef

14.

Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097PubMedCrossRef

15.

von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61:344–349CrossRef

16.

Ahmed R, Freeman JV, Ross B, Kohler B, Nicholl JP, Johnson AG (2000) Long-term response to gallstone treatment: problems and surprises. Eur J Surg 166:447–454PubMedCrossRef

17.

Nicholl JP, Brazier JE, Milner PC, Westlake L, Kohler B, Williams BT, Ross B, Frost E, Johnson AG (1992) Randomised controlled trial of cost-effectiveness of lithotripsy and open cholecystectomy as treatments for gallbladder stones. Lancet 340:801–807PubMedCrossRef

18.

Vetrhus M, Berhane T, Soreide O, Sondenaa K (2005) Pain persists in many patients five years after removal of the gallbladder: observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis. J Gastrointest Surg 9:826–831PubMedCrossRef

19.

Vetrhus M, Soreide O, Nesvik I, Sondenaa K (2003) Acute cholecystitis: delayed surgery or observation: a randomized clinical trial. Scand J Gastroenterol 38:985–990PubMed

20.

Vetrhus M, Soreide O, Solhaug JH, Nesvik I, Sondenaa K (2002) Symptomatic, noncomplicated gallbladder stone disease: operation or observation? A randomized clinical study. Scand J Gastroenterol 37:834–839PubMed

21.

Amir M (2009) Influence of cholecystectomy on symptomatic cholelithiasis: can all symptoms be improved? Rawal Med J 34:141–144

22.

Gilliland TM, Traverso LW (1990) Modern standards for comparison of cholecystectomy with alternative treatments for symptomatic cholelithiasis with emphasis on long-term relief of symptoms. Surg Gynecol Obstet 170:39–44PubMed

23.

Gui GP, Cheruvu CV, West N, Sivaniah K, Fiennes AG (1998) Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow-up. Ann R Coll Surg Engl 80:25–32PubMed

24.

Johnson AG (1971) Gallstones and flatulent dyspepsia: cause or coincidence? Postgrad Med J 47:767–772PubMedCrossRef

25.

Lublin M, Crawford DL, Hiatt JR, Phillips EH (2004) Symptoms before and after laparoscopic cholecystectomy for gallstones. Am Surg 70:863–866PubMed

26.

Qureshi MA, Burke PE, Brindley NM, Leahy AL, Osborne DH, Broe PJ, Bouchier-Hayes DJ, Grace PA (1993) Postcholecystectomy symptoms after laparoscopic cholecystectomy. Ann R Coll Surg Engl 75:349–353PubMed

27.

Rhind JA, Watson L (1968) Gallstone dyspepsia. Br Med J 1:32PubMedCrossRef

28.

Velpen GCV, Shimi SM, Cuschieri A (1993) Outcome after cholecystectomy for symptomatic gallstone disease and effect of surgical access: laparoscopic v open approach. Gut 34:1448–1451CrossRef

29.

Victorzon M, Lundin M, Haglund C, Roberts PJ, Kellokumpu I (1999) Short- and long-term outcome after laparoscopic cholecystectomy. Ann Chir Gynaecol 88:259–263PubMed

30.

Bitzer EM, Lorenz C, Nickel S, Dorning H, Trojan A (2008) Assessing patient-reported outcomes of cholecystectomy in short-stay surgery. Surg Endosc 22:2712–2719PubMedCrossRef

31.

Black NA, Thompson E, Sanderson CF (1994) Symptoms and health status before and six weeks after open cholecystectomy: a European cohort study. ECHSS group. European collaborative health services study group. Gut 35:1301–1305PubMedCrossRef

32.

Bouchier IA, Rhodes K, Brien M (1968) A study of symptomatic and “silent” gallstone. Scand J Gastroenterol 3:299–304PubMedCrossRef

33.

Fenster LF, Lonborg R, Thirlby RC, Traverso LW (1995) What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg 169:533–538PubMedCrossRef

34.

Feretis CB, Feretis AB, Paisis BJ, Kontostavlaki DA, Apostolidu MT, Golematis BC (1983) Managing dyspepsia in gallstone patients. Mt Sinai J Med 50:400–401PubMed

35.

Kingston RD, Windsor CW (1975) Flatulent dyspepsia in patients with gallstones undergoing cholecystectomy. Br J Surg 62:231–233PubMedCrossRef

36.

Scriven MW, Burgess NA, Edwards EA, Morgan AR, Bundred NJ, Lewis MH (1993) Cholecystectomy: a study of patient satisfaction. J R Coll Surg Edinb 38:79–81PubMed

37.

Southam JA (1968) Oesophageal symptoms before and after cholecystectomy. Br J Surg 55:863–864PubMed

38.

Thistle JL, Longstreth GF, Romero Y, Arora AS, Simonson JA, Diehl NN, Harmsen WS, Zinsmeister AR (2011) Factors that predict relief from upper abdominal pain after cholecystectomy. Clin Gastroenterol Hepatol 9:891–896PubMedCrossRef

39.

Abu Farsakh NA, Stietieh M, Abu Farsakh FA (1996) The postcholecystectomy syndrome: a role for duodenogastric reflux. J Clin Gastroenterol 22:197–201PubMedCrossRef

40.

Burney RE, Jones KR (2002) Ambulatory and admitted laparoscopic cholecystectomy patients have comparable outcomes but different functional health status. Surg Endosc 16:921–926PubMedCrossRef

41.

Halldestam I, Kullman E, Borch K (2008) Defined indications for elective cholecystectomy for gallstone disease. Br J Surg 95:620–626PubMedCrossRef

42.

Mjaland O, Hogevold HE, Buanes T (2000) Standard preoperative assessment can improve outcome after cholecystectomy. Eur J Surg 166:129–135PubMedCrossRef

43.

Vignolo MC, Savassi-Rocha PR, Coelho LG, Soares MP, Cardoso-Junior A, Barbosa TF, Ramos FV, Alves TR, Barbosa GM, Pinto DC, Cde CR, Lde CB, de Almeida AM (2008) Gastric emptying before and after cholecystectomy in patients with cholecystolithiasis. Hepatogastroenterology 55:850–854PubMed

44.

Luman W, Adams WH, Nixon SN, McIntyre IM, Hamer-Hodges D, Wilson G, Palmer KR (1996) Incidence of persistent symptoms after laparoscopic cholecystectomy: a prospective study. Gut 39:863–866PubMedCrossRef

45.

Niranjan B, Chumber S, Kriplani AK (2000) Symptomatic outcome after laparoscopic cholecystectomy. Trop Gastroenterol 21:144–148PubMed

46.

Kraag N, Thijs C, Knipschild P (1995) Dyspepsia: how noisy are gallstones? A meta-analysis of epidemiologic studies of biliary pain, dyspeptic symptoms, and food intolerance. Scand J Gastroenterol 30:411–421PubMedCrossRef

47.

Fein M, Bueter M, Sailer M, Fuchs KH (2008) Effect of cholecystectomy on gastric and esophageal bile reflux in patients with upper gastrointestinal symptoms. Dig Dis Sci 53:1186–1191PubMedCrossRef

48.

Quintana JM, Cabriada J, Arostegui I, Oribe V, Perdigo L, Varona M, Bilbao A (2005) Health-related quality of life and appropriateness of cholecystectomy. Ann Surg 241:110–118PubMed

49.

Turner JA, Deyo RA, Loeser JD, Von Korff M, Fordyce WE (1994) The importance of placebo effects in pain treatment and research. J Am Med Assoc 271:1609–1614CrossRef

50.

Vetrhus M, Soreide O, Eide GE, Solhaug JH, Nesvik I, Sondenaa K (2004) Pain and quality of life in patients with symptomatic, noncomplicated gallbladder stones: results of a randomized controlled trial. Scand J Gastroenterol 39:270–276PubMedCrossRef

51.

Bates T, Ebbs SR, Harrison M, A’Hern RP (1991) Influence of cholecystectomy on symptoms. Br J Surg 78:964–967PubMedCrossRef

52.

Corazziari E, Attili AF, Angeletti C, De Santis A (2008) Gallstones, cholecystectomy, and irritable bowel syndrome (IBS) MICOL population-based study. Dig Liver Dis 40:944–950PubMedCrossRef

53.

Kirk G, Kennedy R, McKie L, Diamond T, Clements B (2011) Preoperative symptoms of irritable bowel syndrome predict poor outcome after laparoscopic cholecystectomy. Surg Endosc 25:3379–3384PubMedCrossRef

54.

Bisgaard T, Rosenberg J, Kehlet H (2005) From acute to chronic pain after laparoscopic cholecystectomy: a prospective follow-up analysis. Scand J Gastroenterol 40:1358–1364PubMedCrossRef

55.

Jazrawi S, Walsh TN, Byrne PJ, Hill AD, Li H, Lawlor P, Hennessy TP (1993) Cholecystectomy and oesophageal reflux: a prospective evaluation. Br J Surg 80:50–53PubMedCrossRef

56.

Thune A, Saccone GT, Scicchitano JP, Toouli J (1991) Distension of the gallbladder inhibits sphincter of Oddi motility in humans. Gut 32:690–693PubMedCrossRef

57.

Guyatt GH, Oxman AD, Kunz R, Vist GE, Falck-Ytter Y, Schunemann HJ (2008) What is “quality of evidence” and why is it important to clinicians? Br Med J 336:995–998CrossRef

58.

Gunn A, Keddie N (1972) Some clinical observations on patients with gallstones. Lancet 2:239–241PubMedCrossRef

59.

Jørgensen T, Teglbjerg JS, Wille-Jorgensen P, Bille T, Thorvaldsen P (1991) Persisting pain after cholecystectomy: a prospective investigation. Scand J Gastroenterol 26:124–128PubMedCrossRef

60.

Plaisier PW, van der Hul RL, Nijs HG, den Toom R, Terpstra OT, Bruining HA (1994) The course of biliary and gastrointestinal symptoms after treatment of uncomplicated symptomatic gallstones: results of a randomized study comparing extracorporeal shock wave lithotripsy with conventional cholecystectomy. Am J Gastroenterol 89:739–744PubMed

61.

Ure BM, Troidl H, Spangenberger W, Lefering R, Dietrich A, Eypasch EP, Neugebauer E (1995) Long-term results after laparoscopic cholecystectomy. Br J Surg 82:267–270PubMedCrossRef

62.

Borly L, Anderson IB, Bardram L, Christensen E, Sehested A, Kehlet H, Matzen P, Rehfeld JF, Stage P, Toftdahl DB, Gernow A, Hojgaard L (1999) Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Scand J Gastroenterol 34:1144–1152PubMedCrossRef

63.

Traverso LW, Lonborg R, Pettingell K, Fenster LF (2000) Utilization of cholecystectomy: a prospective outcome analysis in 1,325 patients. J Gastrointest Surg 4:1–5PubMedCrossRef

64.

Mertens MC, De Vries J, Scholtes VP, Jansen P, Roukema JA (2009) Prospective 6 weeks follow-up postcholecystectomy: the predictive value of preoperative symptoms. J Gastrointest Surg 13:304–311PubMedCrossRef

Title: Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness
Authors: Mark P. Lamberts
Marjolein Lugtenberg
Maroeska M. Rovers
Anne J. Roukema
Joost P. H. Drenth
Gert P. Westert
Cornelis J. H. M. van Laarhoven
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Surgical Endoscopy / Issue 3/2013
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-012-2516-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2013

Influence of wrap length on the effectiveness of Nissen and Toupet fundoplications: 5-year results of prospective, randomized study

A prospective evaluation of short-term and long-term results from colonic stenting for palliation or as a bridge to elective operation versus immediate surgery for large-bowel obstruction

Correlation of the gastroesophageal flap valve grade with the surgery rate in patients with gastroesophageal reflux disease

EVA: Laparoscopic Instrument Tracking Based on Endoscopic Video Analysis for Psychomotor Skills Assessment

Revision of failed traditional fundoplication using EsophyX® transoral fundoplication

Stent treatment for fistula after obesity surgery: results in 47 consecutive patients