Role of laparoscopic cholecystectomy in atypical/asymptomatic gall stone disease patients: a randomized controlled trial from a tertiary care centre in North India
DOI:
https://doi.org/10.18203/2349-2902.isj20242450Keywords:
Asymptomatic gallstones, Atypical gallstones, Laparoscopic cholecystectomyAbstract
Background: Gallstone disease (GSD) exhibits considerable heterogeneity, ranging from biliary colic to severe complications such as acute cholecystitis and gallstone pancreatitis. The majority of cases have no prior history of biliary symptoms and are diagnosed incidentally, often labelled as "asymptomatic GSD." Detailed questioning often reveals the presence of vague abdominal discomfort such as pain, dyspepsia, and flatulence.
Methods: In this study, we randomized patients with asymptomatic or atypical gallstone disease into two groups: Group A (Control group) and Group B (Interventional group), where standard laparoscopic cholecystectomy was performed. All patients were followed up at 1 week, 6 months, and 12 months to monitor the development of biliary symptoms, postoperative complaints, and the impact on atypical gastrointestinal symptoms.
Results: The results showed no significant change in atypical symptoms from the initial presentation at the 1-year follow-up in the control group. There were no serious biliary complications or hospitalizations for this subgroup of patients. Among the 13 patients in the observation arm, three (23.1%) underwent laparoscopic cholecystectomy due to the development of biliary colic during the follow-up.
Conclusions: In conclusion, laparoscopic cholecystectomy does not appear to improve atypical abdominal symptoms or decrease the risk of gallbladder carcinoma in patients with asymptomatic GSD from North India. However, surgical intervention may be offered to patients with large stone sizes, as they are at increased risk of becoming symptomatic within 1 year, as observed in our study.
References
Sakorafas GH, Milingos D, Peros G. Asymptomatic cholelithiasis: is cholecystectomy really needed? a critical reappraisal 15 years after the introduction of laparoscopic cholecystectomy. Dig Dis Sci. 2007;52(5):1313-25.
Bülent Mentes B, Akin M, Irkörücü O, Tatliciolu E, Ferahköe Z, Yildinm A, et al. Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy. Surg Endosc. 2001;15(11):1267-72.
Patiño JF, Quintero GA. Asymptomatic cholelithiasis revisited. World J Surg. 1998;22(11):111924.
McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg. 1985;202(1):59-63.
Dutta U, Bush N, Kalsi D, Popli P, Kapoor VK. Epidemiology of gallbladder cancer in India. Chin Clin Oncol. 2019;8(4):33.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424.
Batra Y, Pal S, Dutta U, Desai P, Garg PK, Makharia G, et al. Gallbladder cancer in India: A dismal picture. J Gastroenterol Hepatol. 2005;20(2):309-14.
Mallath M, Patil P. Cholecystectomy for asymptomatic gallstones can reduce gall bladder cancer mortality in Northern Indian women. Indian J Gastroenterol Off J Indian Soc Gastroenterol. 2005;25:147-51.
Gracie WA, Ransohoff DF. The Natural History of Silent Gallstones. N Engl J Med. 1982;307(13):798–800.
Roa I, Aretxabala X de, Roa J, Araya JC, Villaseca M, Guzmán P, et al. Is gallbladder cancer a disease with bad prognosis? Rev Med Chil. 2002;130(11):1295-302.
Gollan JL, Bulkley GB, Diehl AM, Elashoff JD, Federle MP, Hogan WJ, et al. Gallstones and Laparoscopic Cholecystectomy. JAMA. 1993;269(8):1018-24.
