Clinical Outcome after Laparoscopic Cholecystectomy

Yun, Sang Nam; Kim, Sun Whe; Park, Sang Jae; Jang, Jin Young; Park, Yong Hyun

Abstract

BACKGROUND: The indication of a laparoscopic cholecystectomy (LC) for gallstone disease is mainly symptomatic gallstones: the symptoms of gallstones consist of specific symptoms (right upper quadrant (RUQ) pain and epigastric pain) and nonspecific symptoms (dyspepsia, flatulence, belching, loss of appetite, diarrhea, nausea, vomiting, etc.). However, it is not certain that the various symptoms of gallstone patients are due to the gallstone itself or that they are relieved by a laparoscopic cholecystectomy.
METHODS
A self-assessment questionnaire was sent to 500 patients who had undergone a LC between January 1995 and March 1998 at Seoul National University Hospital. Of the 359 patients who replied, 282 patients who had undergone a LC for gallstone disease or acalculous cholecystitis were selected (other patients were underwent LC for polyps, adenomas, or incidental carcinomas, not for gallstones).
RESULTS
Specific symptoms improved in over 90% of the patients (RUQ pain 91.0%, epigastric pain 92.7%) and nonspecific symptoms in over 70% of the patients (vomiting 93.4%, nausea 84.2%, loss of appetite 83.3%, belching 76.2%, dyspepsia 74.8%, and flatulence 73.5%) except for diarrhea (45.2%). Diarrhea (20.6%) and dyspepsia (16.3%) were frequent symptoms which newly developed after a LC. Subjective symptom improvement was observed in 87% of the patients after a LC (cured 47% and improved 40%), and 91% of the patients were satisfied (59.9% fully and 29.4% generally).
CONCLUSIONS
A LC successfully improved not only specific symptoms but also most of the nonspecific gastrointestinal symptoms, except for diarrhea, of gallstone patients. Also, it is very important to try to clarify the exact causes of nonspecific gastrointestinal symptoms in gallstone patients via preoperative differential diagnostic work-up in order to enhance the outcome (symptom improvement and patients' sastisfaction) after a LC.