Mohammed Amir, Mohammad Zubair.
Influence of cholecystectomy on symptomatic cholelithiasis: can all symptoms be improved?.
Rawal Med J Jan ;34(2):141-4.

Objective: To analyze the outcome of cholecystectomies in patients with symptomatic cholelithiasis for improvement in the pre-operative symptoms. Methods This cross-sectional interview-based prospective study included 200 patients who responded to a pre-designed questionnaire in a tertiary care hospital, seen from March 2007 through May 2009. They were interviewed in the post-operative period for improvement in their symptoms at intervals of 1, 3 and 6 months. The patients with common bile duct stones, bilio-enteric fistulae, carcinoma of gall bladder with cholelithiasis, and those lost to follow up were excluded from the study. A benefit ratio (BR) was calculated using SPSS v. 13 for each symptom. BR close to 1.0 was interpreted as evidence of gall stone disease related specifically to the symptom. Results: Out of 200 patients, there were 142 females and 58 males. Mean age was 46.5 years (range 14-92, SD±14.25). 98.5% of patients had abdominal pain associated with gallstones. Other symptoms of variable frequency were nausea (70%), dyspepsia (58.5%), fatty food intolerance (57%), vomiting (25%), heartburn (24.5%) and flatulence (21%). After cholecystectomy, 98.5% patients had complete relief of abdominal pain and vomiting at 6 months (BR=1). Fatty food intolerance seen in 57% patients pre-operatively stayed at 7.5% at six months (BR=0.87). Dyspepsia persisted in 38.5% patients post-operatively (BR=0.34). De novo appearance of symptoms was noted in 5% of patients. 93.5% patients were satisfied with the outcome of surgery. Conclusion: Cholecystectomy appears to relieve specifically biliary pain, nausea, vomiting and fatty food intolerance associated with gallstone disease. Other abdominal symptoms that are non-specific like flatulence, dyspepsia and heartburn are only partly relieved. Despite the persistence or appearance of new symptoms, most patients were satisfied with the outcome of surgery.

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