Surgical referral for cholecystectomy in patients with atypical symptoms

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. A retrospe...

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Bibliographic Details
Published in:The American journal of surgery 2020-12, Vol.220 (6), p.1451-1455
Main Authors: Kapadia, Sonam G., Kaji, Amy H., Hari, Danielle M., Ozao-Choy, Junko, Chen, Kathryn T.
Format: Article
Language:English
Subjects:
Abdomen
Adolescent
Adult
Aged
Aged, 80 and over
Atypical biliary colic
Bile
Calculi
Cholecystectomy
Clinical outcomes
Colic
Decision making
Dyspepsia
Dyspepsia - complications
Female
Gallstones
Gallstones - surgery
Gastritis
Gastritis - complications
Gastroesophageal reflux
Helicobacter Infections - complications
Helicobacter pylori
Humans
Infections
Intervention
Laparoscopy
Male
Middle Aged
Pain
Patients
Referral and Consultation - statistics & numerical data
Retrospective Studies
Signs and symptoms
Surgeons
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Description
Summary: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. A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed. 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. 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. •Surgical referrals for atypical biliary symptoms should elicit broad differentials.•Eliciting history of atypical symptoms preoperatively guides management.•Preoperative heartburn is associated with unresolved symptoms post-cholecystectomy.•Non-operative management of gastritis or H. pylori may alleviate atypical symptoms.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2020.10.016