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Education in practice
How to manage postcholecystectomy abdominal pain
  1. Noor LH Bekkali1,
  2. Kofi W Oppong2,3
  1. 1Department of Gastroenterology and Hepatology, Oxford University Hospitals Trust, John Radcliffe Hospital, Oxford, Oxfordshire, UK
  2. 2HPB Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle, UK
  3. 3Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
  1. Correspondence to Dr Kofi W Oppong, HPB Unit, Freeman Hospital, Newcastle NE7 7DN, UK; kofi.oppong{at}nuth.nhs.uk

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Introduction

Gallstones affect 5%–25% of adults in the Western world, and each year approximately 2%–4% will develop symptoms attributable to gallstones,1 including biliary colic and epigastric pain. Complications of gallstones include acute pancreatitis, acute cholecystitis, biliary obstruction, jaundice and cholangitis. However, 80% of individuals with gallstones will never develop symptoms. Current guidelines do not recommend cholecystectomy for asymptomatic gallstones. Cholecystectomy is the most frequently performed general surgical operation, with approximately 66 660 performed annually in the UK.2 Most cases are performed for gallstone disease; however, a proportion are for presumed gallbladder dyskinesia. Internationally there are large variations within and between countries for cholecystectomy. In the USA, with a population five times that of the UK, greater than 10 times as many cholecystectomies are performed at an estimated cost of $9.9 billion.

Although the majority of patients have pain relief following cholecystectomy, it is estimated that around 40% will continue to have pain postcholecystectomy,3 4 representing a significant number of individuals with morbidity. Postcholecystectomy pain (PCP) may be a persistence of the pain experienced precholecystectomy or a new pain. Patients who had elective rather than emergency surgery and those without stones or who had less typical symptoms are at higher risk to re-present with pain.5 In a recent randomised controlled trial among patients with abdominal pain and gallbladder sludge or stones,6 of a restrictive strategy versus a usual care strategy, 44% and 40% of participants, respectively, experienced PCP. This study highlights the difficulty of ascertaining whether coexisting gallstones are the cause of upper abdominal symptoms. Careful history taking, consideration of other causes and adherence to strict criteria for cholecystectomy all have a role in mitigating against persistence of symptoms postcholecystectomy.

The aim of this review is to discuss the assessment and management of PCP. Acute surgical adverse events will not …

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Footnotes

  • Contributors This review is based on an invited talk given by KWO at the British Society of Gastroenterology Annual Meeting in June 2019. NB and KWO drafted the manuscript and approved the final version. KWO submitted the review and is guarantor for the overall content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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