Surgical referral for cholecystectomy in patients with atypical symptoms.

Autor: Kapadia SG; Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States., Kaji AH; Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States., Hari DM; Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States., Ozao-Choy J; Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States., Chen KT; Department of Surgery, Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA, 1000 West Carson Street, Torrance, CA, 90502, United States. Electronic address: kchen6@dhs.lacounty.gov.
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 2020 Dec; Vol. 220 (6), pp. 1451-1455. Date of Electronic Publication: 2020 Oct 19.
DOI: 10.1016/j.amjsurg.2020.10.016
Abstrakt: Background: Cholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes.
Methods: A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed.
Results: Of 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy - 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0-4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively.
Conclusion: Atypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.
Competing Interests: Declaration of competing interest All authors do not have any financial or personal conflicts of interest to disclose.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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