Biliary symptom scoring as a method of selecting patients for cholecystectomy

Background: A group of patients referred to general surgeons for the treatm ent of gall bladder stones was studied to evaluate the role of a numerical symptom scoring system (biliary symptom score (BSS)) as a tool to improve t he assessment of patients and reduce the incidence of post-cholecystectomy symptoms. Methods: Fifty-seven patients with gallstones and abdominal symptoms referr ed to general surgeons were studied. All patients were interviewed by a sur geon in training independently from the treating surgeon and given a subjec tive and objective assessment of their symptoms (using the BSS); they were then categorized into biliary, non-biliary and possible biliary groups. The results of the interviews remained unknown to the treating surgeon through out the period of study. The symptom status of all patients was reevaluated 6-12 months later: the patients' outcome was compared with their initial o bjective score and the subjective assessment by the independent assessor an d with the treating surgeon's initial assessment, Results: Fifty-one patients were able to be analysed. Subjective independen t assessment and BSS were closely correlated (phi = 0.89). Use of the BSS i mproved the accuracy of the independent assessor from 53% (subjective asses sment) to 69%, but this was at the cost of recommending cholecystectomy in 30% of the patients with non-biliary symptoms. The accuracy of experienced consultant general surgeons was 98% with a single case of post-cholecystect omy syndrome (2%). Conclusion: Numerical BSS improves diagnostic accuracy for a surgeon in tra ining by reducing the number of patients classified with possible biliary s ymptoms, but it remains significantly less accurate than the subjective cli nical assessment of an experienced consultant general surgeon.