A PROSPECTIVE STUDY OF PREDICTORS AND CAUSES OF POSTCHOLECYSTECTOMY PAIN

Document Type : Original Article

Authors

1 Department of Experimental and Clinical Surgery, Medical Research Institute

2 Department of Surgery, Faculty of Medicine, University of Alexandria

Abstract

Aim: A proportion of patients complain of pain after cholecystectomy. The aim of this study was to prospectively identify 
clinical predictors and causes of post-cholecystectomy pain. 
Methods: Forty patients with symptomatic gallstones were interviewed to assess their pain and associated symptoms before and 6 months after cholecystectomy. Patients who suffered from pain (Visual analogue scale - VAS ≥ 4) after cholecystectomy had an ERCP performed with sphincter of Oddi (SO) manometry study. 
Results: Nine patients (22.5%) suffered from pain after cholecystectomy. Univariate and multivariate logistic regression 
identified vomiting as the only independent predictor of post-cholecystectomy pain. Two patients refused further treatment. 
During ERCP and SO motility study a bile duct stone was detected and extracted in one patient. SO manometry was 
performed to the other six patients. Abnormal SO motility was found in five patients and a classical sphincterotomy was 
performed to all patients. After a median of 10 (6-18) months follow-up patients were satisfied with the results of 
sphincterotomy as their VAS decreased from a mean ± SD of 7.0 ± 2.2 to 1.8 ± 0.43. 
Conclusion: Cholecystectomy rids patients of their gallstones but not necessarily their pain. SO dysfunction is the cause in the majority of patients with post-cholecystectomy pain. 

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