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.