Quality of life (GIQLI) and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis)

Abstract

Objective: the aim of this study was to evaluate the incidence, clinical features and role of laparoscopic cholecystectomy (LC) in patients with chronic acalculous cholecystitis (CAC) in comparison with a control group of patients who underwent cholecystectomy for chronic calculous cholecystitis (CCC). Material and methods: prospective evaluation of 34 patients with CAC in contrast with 297 patients with CCC. Outcome measures: clinical presentation, quality of life using the Gastrointestinal Quality of Life Index (GIQLI), usefulness derived from the therapeutic procedure as measured in quality of life units by GIQLI, and clinical efficacy at one year of follow-up. Results: the incidence of complicated biliary disease was higher in CAC (27%), in comparison with CCC (13.8%). The histological study of the excised gallbladder revealed a higher incidence of cholesterolosis associated with chronic cholecystitis in the CAC group (64.9%). GIQLI showed significant differences between preoperative and postoperative measurements in both groups. The associated usefulness of LC was similar in both groups (73 versus 67.3 per cent), confirming an important increase in quality of life for both categories. Conclusions: the incidence of CAC is 11 per cent with a high association with cholesterolosis. Quality of life and LC usefulness are similar to those of patients with CCC. Due to the fact that cholecistogammagraphy is a technique not available in daily clinical practice, and that oral cholecystography and dynamic ultrasound are reliable when a positive result is obtained, extended clinical evaluation is still the most reliable indicator for cholecystectomy.

Changes in Quality-of-Life Following Laparoscopic Cholecystectomy in Adult Patients with Cholelithiasis

“…9 Using GIQLI, Planells et al detected significant and similar quality-of-life improvements following LC in both calculous and acalculous cholecystitis patients. 6 Using both GIQLI and SF-36, Quintana et al found that patients with symptomatic cholelithiasis and low surgical risk experienced the highest quality-of-life gains; patients with asymptomatic cholelithiasis or high surgical risk experienced least improvement. The authors concluded that LC is appropriate for patients with symptomatic gallstone and low surgical risk.…”

“…5 However, there are limited researches in the literatures that have reported LC quality-of-life outcomes. [6][7][8][9][10] The quality-of-life impacts of LC and the predictors of patients' subjective outcomes remained undetermined, especially in the Asian context. The aims of this study are to use the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and Gastrointestinal Quality of Life Index (GIQLI) surveys to report subjective quality-oflife following LC and to investigate the factors that may predict LC quality-of-life outcomes in adults with cholelithiasis.…”

Outpatient laparoscopic cholecystectomy: A new gold standard for cholecystectomy?

“…Anti-emetic prevention, the utilization of propofol as a rapid anesthetic inductor with minimal undesirable residual effects, and the association during anesthetic induction of NSAIDs (ketorolac) have all permitted a successful ambulatorization of LC (6,13,14), which is according to various series around 55-97% (12)(13)(14)(15). Table V shows series reported along the development of the outpatient approach, including case numbers and ambulatorization percentage (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33).…”

“…In fact, acceptance before the ambulatory procedure shows differences among the various degrees of information demanded according to patient age, sex, education. Such information must assure home self-management during the postoperative period, and be exhaustive in order to ensure maximal quality of care, thus avoiding the undesirable effects of surgery "without information", which originates a high percentage of complications that remain undetected by the surgical unit (21,22).…”

Quality-of-life measures in Taiwanese adults with symptomatic gallstone disease

“…Unexplored is the correlation of quality of life with liver enzyme measures, including serum levels of alkaline phosphatase, direct and total bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST). Using general health status and gastrointestinal health-specific measuring instruments [6][7][8], the objectives of this study were to investigate the association of qualityof-life status with baseline laboratory findings and to elucidate quality-of-life predictors among Taiwanese adults undergoing surgery for symptomatic gallstone disease.…”