Skip to main content
SpringerLink
Log in

Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up

A long-term prospective cohort study

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Up to 41 % of patients report pain after cholecystectomy and in most studies follow-up for these symptoms did not exceed 5 years. The episodic nature of abdominal pain associated with symptomatic cholelithiasis warrants long-term follow-up studies. We assessed which patient and surgical factors were associated with absence of pain and patient-reported success of surgery after ≥5 years of follow-up.

Methods

Patients of ≥18 years of age with symptomatic cholelithiasis, classified as ASA I or II, who had previously returned a preoperative questionnaire were sent a questionnaire consisting of the gastrointestinal quality of life index (GIQLI) and patient ratings of current versus presurgical abdominal symptoms and of surgery result. Logistic regression analysis was performed to determine associations.

Results

Questionnaires were sent to 197 patients and returned by 126 (64.0 %) patients (73.8 % female, mean age at surgery 47.5 ± 12.2 years) at a mean of 10.0 ± 1.0 years after cholecystectomy. Absence of abdominal pain was reported by 60.3 % of the patients. Patients classified as ASA II as opposed to ASA I were less likely to report absence of pain (OR 0.41, 95 % CI 0.17–0.99). A positive rating of long-term postsurgical versus presurgical abdominal symptoms was given by 89.7 % of the patients and 90.5 % considered the cholecystectomy result to be good. No variables were significantly associated with these latter two outcome measures.

Conclusions

We found a high patient-reported surgery success rate after >5 years of follow-up after cholecystectomy despite residual abdominal pain in some of these patients. None of the patient and surgery-related characteristics were consistently associated with all three outcome measures. This discrepancy between patient’ outcomes highlights the need for realistic expectations prior to cholecystectomy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  7. Jones C, Mawhinney A, Brown R (2012) The true cost of gallstone disease. Ulst med J 81:10–13

    Google Scholar 

  8. Keus F, de Jonge T, Gooszen HG, Buskens E, van Laarhoven CJ (2009) Cost-minimization analysis in a blind randomized trial on small-incision versus laparoscopic cholecystectomy from a societal perspective: sick leave outweighs efforts in hospital savings. Trials 10:80

    Article  PubMed Central  PubMed  Google Scholar 

  9. Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, van Laarhoven CJ (2013) Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc 27:709–718

    Article  PubMed  Google Scholar 

  10. 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 9:891–896

    Article  PubMed  Google Scholar 

  11. 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 166:447–454

    Article  CAS  PubMed  Google Scholar 

  12. Konsten J, Gouma DJ, von Meyenfeldt MF, Menheere P (1993) Long-term follow-up after open cholecystectomy. Br J surg 80:100–102

    Article  CAS  PubMed  Google Scholar 

  13. Sand J, Pakkala S, Nordback I (1996) Twenty to thirty year follow-up after cholecystectomy. Hepatogastroenterology 43:534–537

    CAS  PubMed  Google Scholar 

  14. Schmidt M, Sondenaa K, Vetrhus M, Berhane T, Eide GE (2011) A randomized controlled study of uncomplicated gallstone disease with a 14-year follow-up showed that operation was the preferred treatment. Dig Surgery 28:270–276

    Article  Google Scholar 

  15. 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 9:826–831

    Article  PubMed  Google Scholar 

  16. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL (2003) The implications of regional variations in medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med 138:288–298

    Article  PubMed  Google Scholar 

  17. Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL (2003) The implications of regional variations in medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med 138:273–287

    Article  PubMed  Google Scholar 

  18. Harrison EM, O’Neill S, Meurs TS, Wong PL, Duxbury M, Paterson-Brown S, Wigmore SJ, Garden OJ (2012) Hospital volume and patient outcomes after cholecystectomy in Scotland: retrospective, national population based study. BMJ 344:e3330

    Article  PubMed  Google Scholar 

  19. Keus F, de Vries J, Gooszen HG, van Laarhoven CJ (2008) Laparoscopic versus small-incision cholecystectomy: health status in a blind randomised trial. Surg Endosc 22:1649–1659

    Article  PubMed Central  PubMed  Google Scholar 

  20. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmulling C, Neugebauer E, Troidl H (1995) Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg 82:216–222

    Article  CAS  PubMed  Google Scholar 

  21. Nieveen Van Dijkum EJ, Terwee CB, Oosterveld P, Van Der Meulen JH, Gouma DJ, De Haes JC (2000) Validation of the gastrointestinal quality of life index for patients with potentially operable periampullary carcinoma. Br J Surg 87:110–115

    Article  CAS  PubMed  Google Scholar 

  22. Black N, Petticrew M, Hunter D, Sanderson C (1993) Day surgery: development of a national comparative audit service. Qual Health Care 2:162–166

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Black N, Sanderson C (1993) Day surgery; development of a questionnaire for eliciting patients’ experiences. Qual Health Care 2:157–161

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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

    Article  Google Scholar 

  25. 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 241:110–118

    PubMed Central  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  28. Zapf M, Denham W, Barrera E, Butt Z, Carbray J, Wang C, Linn J, Ujiki M (2013) Patient-centered outcomes after laparoscopic cholecystectomy. Surg Endosc 27:4491–4498

    Article  PubMed  Google Scholar 

  29. Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, Capodicasa S, Romano F, Roda E, Colecchia A (2010) Natural history of gallstone disease: expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol 25:719–724

    Article  PubMed  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  31. American College of P (2008) Information on cost-effectiveness: an essential product of a national comparative effectiveness program. Ann Intern Med 148:956–961

    Article  Google Scholar 

Download references

Disclosures

Mark P. Lamberts, Brenda L. Den Oudsten, Frederik Keus, Jolanda De Vries, Cornelis J. H. M. van Laarhoven, Gert P. Westert, Joost P. H. Drenth, Jan A. Roukema have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Mark P. Lamberts & Joost P. H. Drenth

  2. Department of Medical and Clinical Psychology, CoRPS, Tilburg University, Tilburg, The Netherlands

    Brenda L. Den Oudsten & Jolanda De Vries

  3. Department of Critical Care, University Medical Centre Groningen, Groningen, The Netherlands

    Frederik Keus

  4. Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands

    Jolanda De Vries

  5. Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

    Mark P. Lamberts & Cornelis J. H. M. van Laarhoven

  6. Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboud University Medical Centre, Nijmegen, The Netherlands

    Mark P. Lamberts & Gert P. Westert

  7. Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands

    Jan A. Roukema

Authors
  1. Mark P. Lamberts
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brenda L. Den Oudsten
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Frederik Keus
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jolanda De Vries
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cornelis J. H. M. van Laarhoven
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gert P. Westert
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joost P. H. Drenth
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jan A. Roukema
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark P. Lamberts.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lamberts, M.P., Oudsten, B.L.D., Keus, F. et al. Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up. Surg Endosc 28, 3443–3450 (2014). https://doi.org/10.1007/s00464-014-3619-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-014-3619-2

Keywords

Search

Navigation