Frequency of Cholecystectomy and Investigation of Related Factors in Asymptomatic Gallstones

Year 2021, , 3 - 7, 20.04.2021

Ali Kırık , Ali Cem Yekdeş , Uğur Ergün , Burak Alp , Merve Nur Ak , Teoman Doğru

https://doi.org/10.46332/aemj.776273

Cited By: 2

Abstract

Purpose: While cholecystectomy is recommended for the treatment of symptomatic gallstones in current guidelines, surgery is not recommended in asymptomatic cases. In this study, we aimed to investigate the frequency of cholecystectomy and the factors affecting the approach to asymptomatic gallstones in clinical practice.

Material and Methods: This study was designed as a prospective survey study. In this study, cases who had undergone cholecystectomy for gallstones in the past were evaluated. The survey was administered by face-to-face interview method and each patient was asked questions about surgical indication, medical information and symptoms.

Results: In this study (n=212); 75 (35.4%) cases had asymptomatic gallstones and were operated on for prophylactic purposes; 137 (64.6%) cases were found to have been operated on due to certain indications (presence of dyspeptic symptoms, acute cholecystitis, porcelain gallbladder, etc.). In the surgical decision with inappropriate indication; it was observed that the departments of general surgery (64%), internal medicine (29.3%) and gastroenterology (4%) played a role. However, in some of the cases; it was found that dyspeptic complaints such as abdominal pain, bloating, nausea and epigastric burning continued after the surgery.

Conclusion: Today, inappropriate surgical treatment in asymptomatic gallstones is common, and approximately one out of every three patients is decided to undergo surgery. Therefore, it is considered that the medical and legal adverse situations that may occur can be prevented by reconsidering the issue by the relevant fields of speciality

Keywords

acute cholecystitis, cholecystectomy, asymptomatic gallstones

Asemptomatik Safra Taşlarında Kolesistektomi Sıklığı ve İlişkili Faktörlerin Araştırılması

Abstract

Amaç: Güncel rehberlerde semptomatik safra taşlarının tedavisinde kolesistektomi önerilirken asemptomatik olgularda cerrahi önerilmemektedir. Bu çalışmada, klinik pratikte asemptomatik safra taşlarına yaklaşımda kolesistektomi sıklığı ve etki eden faktörlerin araştırılması amaçlanmıştır.

Araçlar ve Yöntem: Bu çalışma prospektif, kesitsel nitelikte ve tanımlayıcı bir anket çalışması olarak tasarlanmıştır. Çalışmada kapsamında geçmişte safra taşı nedeni ile kolesistektomi uygulanan olgular değerlendirilmiştir. Yüz yüze görüşme yöntemi ile uygulanan ankette başlıca; cerrahi endikasyon, tıbbi bilgilendirme ve semptom değişimi yönünden bilgiler değerlendirilmiştir

Bulgular: Bu çalışmada kolesistektomi endikasyonları incelendiğinde; 75 (%35.4) olguda asemptomatik safra taşı olduğu ve profilaksi amaçlı opere edildiği; 62 (%29.2) olgu akut kolesistit, 6 (%2.8) olgu koledokolitiyazis, 1 (%0.5) olgu porselen kese, 3 (%1.4) olgu akut pankreatit, 2 (%0.9) olgu polip birlikteliği ve 63 (%29.7) olgunun ise semptomatik safra taşı nedeniyle opere edildiği belirlendi. Uygun olmayan endikasyonla cerrahi kararı verilmesinde; %64 ile genel cerrahi, %29.3 ile iç hastalıkları ve %4 ile gastroenteroloji bölümleri gözlendi.

Sonuç: Asemptomatik safra taşlarında endikasyon dışı cerrahi tedavi uygulanması günümüzde sık görülen bir durumdur. Bu nedenle konunun ilgili branşlar tarafından yeniden ele alınarak oluşabilecek tıbbi ve hukuki olumsuz durumların önlenebileceği değerlendirilmektedir.

Keywords

akut kolesistit, asemptomatik safra taşı, kolesistektomi

References

• 1. Ibrahim M, Sarvepalli S, Morris-Stiff G et al. Gallstones:Watch and wait, or intervene? Cleve Clin J Med. 2018;85(4):323-331.
• 2. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-187.
• 3. Lammert F, Acalovschi M, Ercolani G, et al. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-181.
• 4. Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7(2):132-140.
• 5. Njeze GE. Gallstones. Niger J Surg. 2013;19(2):49-55.
• 6. Portincasa P, Di Ciaula A, De Bari O, Garruti G, Palmieri VO, Wang DQ. Management of gallstones and its related complications. Expert Rev Gastroenterol Hepatol. 2016;10(1):93-112.
• 7. Baron TH, Grimm IS, Swanstrom LL. Interventional Approaches to Gallbladder Disease. N Engl J Med. 2015;373(4):357-365.
• 8. Quintana JM, Cabriada J, Aróstegui I et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005;241(1):110-118.
• 9. Quintana JM, Cabriada J, Lopez DT, et al. Development of explicit criteria for cholecystectomy. Qual Saf Health Care. 2002;11(4):320-326.
• 10. Noel R, Arnelo U, Enochsson L, Lundell L, Nilsson M, Sandblom G. Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease. Scand J Gastroenterol. 2016;51(4):465-471.
• 11. Murshid KR. Asymptomatic gallstones: Should we operate? Saudi J Gastroenterol 2007;13(2):57-69.
• 12. Lamberts MP. Indications of cholecystectomy in gallstone disease. Curr Opin Gastroenterol 2018;34(2):97-102.
• 13. Lamberts MP, Lugtenberg M, Rovers MM, et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013;27(3):709-718.
• 14. Karmacharya A, Malla BR, Joshi HN, et al. The predictive value of pre-operative symptoms including upper gastrointestinal endoscopy before laparoscopic cholecystectomy for elective symptomatic cholecystolithiasis. Kathmandu Univ Med J. 2013;11(4):300-304.
• 15. Quintana JM, Cabriada J, López de Tejada I, Perdigo L, Aróstegui I, Bilbao A. Appropriateness variation in cholecystectomy. Eur J Public Health. 2004;14(3):252-257.