Objective: To evaluate the effect of cholecystectomy in patients with gallstones on preoperative abdominal symptoms.
Methods: A systematic search was made of the Medline database in combination with reference checking. Articles were excluded if patients aged <18 years, symptom relief rates could not be calculated, if follow-up after cholecystectomy was less than 1 month, or when the included patients were at extraordinary risk for a complicated outcome. Potential differences in relief rates due to patient selection, retrospective versus prospective design, duration of follow-up, or intervention were analyzed using logistic regression.
Results: The pooled relief rate for "biliary pain" was high 92% (95% confidence interval 86 to 96%). Symptom relief rates were consistently higher in studies that included acute cholecystectomies. For upper abdominal pain--without restrictions for intensity or duration--pooled relief rates ranged from 72% (66 to 77%) after elective cholecystectomy, to 86% (83 to 91%) after acute cholecystectomy. The relief rate of food intolerance was higher in studies with a follow-up < or =12 months (88%, 76 to 91%) compared to studies with a follow-up of more than 12 months (65%, 55 to 74%).
Conclusion: In almost all patients with gallstones biliary pain disappeared after cholecystectomy. There is insufficient evidence, however, that this relief was due to cholecystectomy. Relief rates of other isolated symptoms were low in patients with an elective cholecystectomy. A proper evaluation of the effectiveness of cholecystectomy in terms of abdominal symptom relief rates requires a randomized trial.