Introduction: The purpose of this study was to determine if laparoscopic cholecystectomy (LC) in patients with cholelithiasis and dyspepsia will produce complete symptomatic relief one year after surgery. In this study dyspepsia was defined by a validated scoring system which measured epigastric pain, heartburn, belching and bloating.
Methods: Patients undergoing LC for uncomplicated gallstone disease in three university affiliated hospitals, from January 1, 2004 to June 30, 2005 received a validated questionnaire one year after surgery. This population based study used the questionnaire to identify patients with cholelithiasis and dyspepsia (Group I). For each symptom, the severity, frequency and duration were quantified using a Likert scale to produce a preoperative and postoperative total score per patient. Preoperative scores greater than 16 identified Group I patients. Postoperative scores less than 6 defined complete cessation of symptoms. Each gallbladder specimen was examined by a single pathologist blinded to patient clinical information.
Results: The survey response rate from 942 patients was 43%. Group I (N=264) were dyspeptic (77%); Group II (N=79) who had scores less than 16, had no dyspepsia (23%). Although Group I patients were improved overall one year after surgery (median postoperative total score: 12); only 40 patients (18.6%) achieved complete cessation of symptoms (scores <6). Ninety six patients (36.4%) had persisting dyspepsia (scores >16). One hundred and nineteen patients (45.1%) had reduced scores (7-15) one year after operation. Analysis of this subset identifed only pain was significantly reduced (p<0.001). Pathological examination of these 119 gallbladders revealed histological evidence of acute cholecystitis in 57%, which accounts for the pain reduction in this subset. One hundred and forty four of all Group I patients (54.5%) had acute cholecystitis. Only 99 (37.5%) had chronic cholecystitis; 21 (8.0%) had normal gallbladders with cholelithiasis.
Conclusions: This is the largest study to report outcomes for patients with gallstones and dyspepsia one year after LC. The majority of patients do not achieve complete cessation of symptoms. Pain was relieved more than other dyspeptic symptoms in this population. Half of the study group had acute inflammation of the gallbadder on histopathological examination.