Relationship between persistence of abdominal symptoms and successful outcome after cholecystectomy

Background: Patients frequently have persistent abdominal symptoms after un dergoing cholecystectomy. The relationship between abdominal symptoms and b iliary dysfunction is often unclear. Objectives: To describe the persistence rate of abdominal symptoms in a lar ge cohort of patients after elective cholecystectomy, to identify predictor s of symptom persistence and operative success, to understand which symptom s improve after cholecystectomy, and to describe the important determinants of an unsuccessful operation. Methods: Secondary analysis of a prospective, multisite cohort study of 248 1 patients undergoing elective cholecystectomy. Results: The mean +/- SD number of abdominal symptoms per patient decreased from 3.1 +/- 2.0 to 1.1 +/- 1.3; 27% of patients who identified a symptom as most bothersome before surgery still had the symptom 6 months after surg ery. Symptom persistence rates ranged from 5.6% (vomiting) to 40.2% (gas/fl atulence). A balance score that quantified the abdominal symptom mix betwee n dyspeptic and biliary symptoms shifted after surgery to the dyspeptic cat egory. Predictors of persistence of a most bothersome symptom were dyspepti c symptom category, worse operative risk and self-rated health status, symp tom duration longer than 6 months, and no previous episodes of acute cholec ystitis. The major correlate of not achieving a very successful outcome (15 .2% of patients) was the presence of postoperative abdominal pain. Other pr edictors included worse self-rated health status and physical functioning, symptom duration longer than 6 months before surgery, and no previous episo des of acute cholecystitis. Conclusions: Symptoms categorized as dyspeptic were more likely to persist than were biliary symptoms, although all symptoms showed a decrease in prev alence after cholecystectomy. More attention to the rationale for gallbladd er removal and clarification of patient expectations for symptom relief mig ht be necessary to improve outcomes after elective cholecystectomy.