Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):58-65. 10.14701/ahbps.2018.22.1.58.

Index admission laparoscopic cholecystectomy for acute cholecystitis restores Gastrointestinal Quality of Life Index (GIQLI) score

• Yu H
• Chan EE
• Lingam P
• Lee J
• Woon WW
• Low JK
• Shelat VG

• KMID: 2409081
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.58

Abstract

BACKGROUNDS/AIMS
Previous studies have evaluated quality of life (QoL) in patients who underwent laparoscopic cholecystectomy (LC) for cholelithiasis. The purpose of this study was to evaluate QoL after index admission LC in patients diagnosed with acute cholecystitis (AC) using the Gastrointestinal Quality of Life Index (GIQLI) questionnaire.
METHODS
Patients ≥21 years admitted to Tan Tock Seng Hospital, Singapore for AC and who underwent index admission LC between February 2015 and January 2016 were evaluated using the GIQLI questionnaire preoperatively and 30 days postoperatively.
RESULTS
A total of 51 patients (26 males, 25 females) with a mean age of 60 years (24-86 years) were included. Median duration of abdominal pain at presentation was 2 days (1-21 days). 45% of patients had existing comorbidities, with diabetes mellitus being most common (33%). 31% were classified as mild AC, 59% as moderate and 10% as severe AC according to Tokyo Guideline 2013 (TG13) criteria. Post-operative complications were observed in 8 patients, including retained common bile duct stone (n=1), wound infection (n=2), bile leakage (n=2), intra-abdominal collection (n=1) and atrial fibrillation (n=2). 86% patients were well at 30 days follow-up and were discharged. A significant improvement in GIQLI score was observed postoperatively, with mean total GIQLI score increasing from 106.0±16.9 (101.7-112.1) to 120.4±18.0 (114.8-125.9) (p < 0.001). Significant improvements were also observed in GIQLI subgroups of gastrointestinal symptoms, physical status, emotional status and social function status.
CONCLUSIONS
Index admission LC restores QoL in patients with AC as measured by GIQLI questionnaire.

Keyword

Acute cholecystitis; Gastrointestinal Quality of Life Index (GIQLI); Quality of life

MeSH Terms

Abdominal Pain
Atrial Fibrillation
Bile
Cholecystectomy, Laparoscopic*
Cholecystitis, Acute*
Cholelithiasis
Common Bile Duct
Comorbidity
Diabetes Mellitus
Follow-Up Studies
Humans
Male
Quality of Life*
Singapore
Triacetoneamine-N-Oxyl
Wound Infection
Triacetoneamine-N-Oxyl

Figure

• 

  Fig. 1 Patient inclusion flowchart. AC, acute cholecystitis; TTSH, Tan Tock Seng Hospital.

• 

  Fig. 2 Comparison of Pre-operative and Post-operative total GIQLI score. Pre-op, pre-operative; Post-op, post-operative; GIQLI, Gastrointestinal Quality of Life Index.

• 

  Fig. 3 Subgroup comparisons of pre-operative and post-operative GIQLI score. Pre-op, pre-operative; Post-op, post-operative; GIQLI, Gastrointestinal Quality of Life Index.

Reference

1. Miura F, Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gouma DJ, et al. TG13 flowchart for the management of acute cholangitis and cholecystitis. J Hepatobiliary Pancreat Sci. 2013; 20:47–54.

2. Ansaloni L, Pisano M, Coccolini F, Peitzmann AB, Fingerhut A, Catena F, et al. 2016 WSES guidelines on acute calculous cholecystitis. World J Emerg Surg. 2016; 11:25.

3. Tan CH, Pang TC, Woon WW, Low JK, Junnarkar SP. Analysis of actual healthcare costs of early versus interval cholecystectomy in acute cholecystitis. J Hepatobiliary Pancreat Sci. 2015; 22:237–243.

4. Ahmed S, de Souza NN, Qiao W, Kasai M, Keem LJ, Shelat VG. Quality of life in hepatocellular carcinoma patients treated with transarterial chemoembolization. HPB Surg. 2016; 2016:6120143.

5. Shelat VG, Eileen S, John L, Teo LT, Vijayan A, Chiu MT. Chronic pain and its impact on quality of life following a traumatic rib fracture. Eur J Trauma Emerg Surg. 2012; 38:451–455.

6. Eypasch E, Wood-Dauphinée S, Williams JI, Ure B, Neugebauer E, Troidl H. The Gastrointestinal Quality of Life Index. A clinical index for measuring patient status in gastroenterologic surgery. Chirurg. 1993; 64:264–274.

7. Eypasch E, Williams JI, Wood-Dauphinee S, Ure BM, Schmülling C, Neugebauer E, et al. Gastrointestinal Quality of Life Index: development, validation and application of a new instrument. Br J Surg. 1995; 82:216–222.

8. Quintana JM, Cabriada J, López de, Varona M, Oribe V, Barrios B, et al. Translation and validation of the gastrointestinal Quality of Life Index (GIQLI). Rev Esp Enferm Dig. 2001; 93:693–706.

9. Sandblom G, Videhult P, Karlson BM, Wollert S, Ljungdahl M, Darkahi B, et al. Validation of Gastrointestinal Quality of Life Index in Swedish for assessing the impact of gallstones on health-related quality of life. Value Health. 2009; 12:181–184.

10. Lien HH, Huang CC, Wang PC, Chen YH, Huang CS, Lin TL, et al. Validation assessment of the Chinese (Taiwan) version of the Gastrointestinal Quality of Life Index for patients with symptomatic gallstone disease. J Laparoendosc Adv Surg Tech A. 2007; 17:429–434.

11. Lamberts MP, Den Oudsten BL, Keus F, De Vries J, van Laarhoven CJ, Westert GP, et al. Patient-reported outcomes of symptomatic cholelithiasis patients following cholecystectomy after at least 5 years of follow-up: a long-term prospective cohort study. Surg Endosc. 2014; 28:3443–3450.

12. Lamberts MP, Den Oudsten BL, Gerritsen JJ, Roukema JA, Westert GP, Drenth JP, et al. Prospective multicentre cohort study of patient-reported outcomes after cholecystectomy for uncomplicated symptomatic cholecystolithiasis. Br J Surg. 2015; 102:1402–1409.

13. Mentes BB, Akin M, Irkörücü O, Tatlicioğlu E, Ferahköşe Z, Yildinm A, et al. Gastrointestinal quality of life in patients with symptomatic or asymptomatic cholelithiasis before and after laparoscopic cholecystectomy. Surg Endosc. 2001; 15:1267–1272.

14. Eriksen JR, Kristiansen VB, Hjortsø NC, Rosenberg J, Bisgaard T. Effect of laparoscopic cholecystectomy on the quality of life of patients with uncomplicated socially disabling gallstone disease. Ugeskr Laeger. 2005; 167:2654–2656.

15. Chen L, Tao SF, Xu Y, Fang F, Peng SY. Patients' quality of life after laparoscopic or open cholecystectomy. J Zhejiang Univ Sci B. 2005; 6:678–681.

16. Finan KR, Leeth RR, Whitley BM, Klapow JC, Hawn MT. Improvement in gastrointestinal symptoms and quality of life after cholecystectomy. Am J Surg. 2006; 192:196–202.

17. Shi HY, Lee KT, Lee HH, Uen YH, Chiu CC. Response shift effect on gastrointestinal quality of life index after laparoscopic cholecystectomy. Qual Life Res. 2011; 20:335–341.

18. Planells Roig M, Bueno Lledó J, Sanahuja Santafé A, García Espinosa R. Quality of life (GIQLI) and laparoscopic cholecystectomy usefulness in patients with gallbladder dysfunction or chronic non-lithiasic biliary pain (chronic acalculous cholecystitis). Rev Esp Enferm Dig. 2004; 96:442–446. 446–451.

19. Quintana JM, Cabriada J, Aróstegui I, López de, Bilbao A. Quality-of-life outcomes with laparoscopic vs open cholecystectomy. Surg Endosc. 2003; 17:1129–1134.

20. Quintana JM, Arostegui I, Oribe V, López de, Barrios B, Garay I. Influence of age and gender on quality-of-life outcomes after cholecystectomy. Qual Life Res. 2005; 14:815–825.

21. Quintana JM, Aróstegui I, Cabriada J, López de, Perdigo L. Predictors of improvement in health-related quality of life in patients undergoing cholecystectomy. Br J Surg. 2003; 90:1549–1555.

22. Shi HY, Lee HH, Tsai JT, Ho WH, Chen CF, Lee KT, et al. Comparisons of prediction models of quality of life after laparoscopic cholecystectomy: a longitudinal prospective study. PLoS One. 2012; 7:e51285.

23. Lamberts MP, Kievit W, Gerritsen JJ, Roukema JA, Westert GP, Drenth JP, et al. Episodic abdominal pain characteristics are not associated with clinically relevant improvement of health status after cholecystectomy. J Gastrointest Surg. 2016; 20:1350–1358.

24. Quintana JM, Cabriada J, Aróstegui I, Oribe V, Perdigo L, Varona M, et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005; 241:110–118.

25. Wanjura V, Sandblom G. How do quality-of-life and gastrointestinal symptoms differ between post-cholecystectomy patients and the background population. World J Surg. 2016; 40:81–88.

26. Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2013; 20:35–46.

27. Wanjura V, Lundström P, Osterberg J, Rasmussen I, Karlson BM, Sandblom G. Gastrointestinal quality-of-life after cholecystectomy: indication predicts gastrointestinal symptoms and abdominal pain. World J Surg. 2014; 38:3075–3081.

28. Lien HH, Huang CC, Wang PC, Huang CS, Chen YH, Lin TL, et al. Changes in quality-of-life following laparoscopic cholecystectomy in adult patients with cholelithiasis. J Gastrointest Surg. 2010; 14:126–130.

29. Lamberts MP, Lugtenberg M, Rovers MM, Roukema AJ, Drenth JP, Westert GP, et al. Persistent and de novo symptoms after cholecystectomy: a systematic review of cholecystectomy effectiveness. Surg Endosc. 2013; 27:709–718.

30. Weinert CR, Arnett D, Jacobs D Jr, Kane RL. Relationship between persistence of abdominal symptoms and successful outcome after cholecystectomy. Arch Intern Med. 2000; 160:989–995.

31. Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013; (6):CD005440.

32. Amirthalingam V, Low JK, Woon W, Shelat V. Tokyo Guidelines 2013 may be too restrictive and patients with moderate and severe acute cholecystitis can be managed by early cholecystectomy too. Surg Endosc. 2017; 31:2892–2900.

33. Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998; 227:461–467.