Browsing by Author "Turunen, Henni"

Background Gallstones are common in the Western adult population: their incidence is 10-20 %. Half of the patients are asymptomatic when the gallstones are diagnosed. Uncomplicated, symptomatic cholecystolithiasis means that the gallstones generate pain, but the disease has not developed any complications. The treatment for symptomatic patients is cholecystectomy which is normally made in laparoscopy. Despite the operation, pain continues in 28 % of the electively operated patients. The purpose of this systematic review is to find out based on literature whether there is a patient group that does not benefit from the operation or what the characteristics of such patients are. Methods The source of the literature is Ovid Medline database. The research question has been divided into PICO keywords and 790 results have been found. The results have been reviewed by title, abstract, and by the whole text, and the articles that do not fulfil the inclusion criteria have been ruled out. The articles have to concern people minimum of 18 years old that have had their gallbladder removed because of symptomatic, uncomplicated cholecystolithiasis. In addition, some symptom and quality of life parameters must have been asked before and after operation. Eventually, there are 22 articles left that the systematic review is based on. These articles have been reviewed with the Newcastle-Ottawa scale. Results There is no research on the patient group that does not benefit from the cholecystectomy, but there are parameters found that have an impact on the benefit. High-level anxiety increases the risk of continuous pain up to three times higher. Alexithymia and psychologic distress are more common in patients that have continuous abdominal symptoms after the operation. High pain frequency is linked to worse postoperative pain relief. To get the best benefit from the operation, pain symptoms need to be typical and intense, but pain frequency low. Female gender and functional gastrointestinal disorder are connected to worse outcome. Pain duration more than a year, high score in preoperative quality of life questionnaire, and episodic pain predict pain relief after the operation. Discussion According to the systematic review, there is no research on who should not be operated because of symptomatic, uncomplicated cholecystolithiasis. However, some parameters that predict worse operation outcome have been found. Further research on the topic is needed to find out the parameters that determine whether the patients get benefit from the operation.