Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness
until further notice
SourceSurgical Endoscopy and Other Interventional Techniques, 27, 3, (2013), pp. 709-718
Article / Letter to editor
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Epidemiology, Biostatistics & HTA
Surgical Endoscopy and Other Interventional Techniques
SubjectIGMD 2: Molecular gastro-enterology and hepatology; IGMD 2: Molecular gastro-enterology and hepatology NCMLS 5: Membrane transport and intracellular motility; NCEBP 2: Evaluation of complex medical interventions; NCEBP 2: Evaluation of complex medical interventions ONCOL 4: Quality of Care; NCEBP 4: Quality of hospital and integrated care
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.
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