AbstractPhilipe Mouret performed the first laparoscopic cholecystectomy in 1987, and since then it has become the ‘gold standard’ treatment for symptomatic gallstones. It had undoubted benefits over the conventional open procedure, such as reduced morbidity and mortality, a shorter hospital stay and quicker return to normal daily activities. This improved risk to benefit ratio has seen an increasing number of cholecystectomies performed, without a parallel increase in the prevalence of gallstones. This could represent a higher patient demand for ‘key hole’ surgery, or a reduced threshold for intervention, with surgery being performed for poorly defined indications such as functional gastrointestinal disorders.
Independent of the operative technique, there is a significant proportion of patients who complain of persistent symptoms after cholecystectomy, a condition described as postcholecystectomy syndrome. There is evidence to show that patients who experience a predominance of functional symptoms such as altered bowel habit and those requiring psychotropic medications have a higher rate of persistent symptoms following surgery.
Irritable bowel syndrome is a functional colonic disorder characterised by abdominal discomfort, along with altered defaecation or change in bowel habit. Many of the symptoms of IBS overlap with those of functional dyspepsia or gallstones, and a higher rate of anxiety and depression has been observed in this group. As yet there is no study to show that patients with irritable bowel syndrome and gallstones have a worse outcome after cholecystectomy, but population based studies have shown that they do have a higher rate of cholecystectomy when compared with the general population. A significant proportion of these patients may be having cholecystectomies for symptoms of colonic rather than biliary origin. If we could predict patients who were less likely to benefit from surgery, and treat them expectantly, there would be financial gains and benefits in terms of patients’ health from reduced morbidity by unnecessary surgery.
Quality of life assessment is a measurement tool that researchers can use to investigate outcome after an intervention or treatment. Methods of assessing quality of life and its clinical application have gained popularity and improved significantly over the last decade. In this study, quality of life measurement is the principle means used to examine what effect irritable bowel syndrome has on outcome after laparoscopic cholecystectomy.
|Date of Award||Dec 2005|
|Supervisor||W.D.B. Clements (Supervisor) & Thomas Diamond (Supervisor)|