Comparison of Quality of Life After Single Stage vs. Two Stage Management of Patients with Concomitant Gall Stones and Common Bile Duct Stones:a Prospective Randomized Control Trial

Virinder K Bansal, Krishna Asuri, Sunita Suman, Omprakash Prajapati, Pramod Garg, Rajesh Sagar, Mahesh C Misra. All India Institute of Medical Sciences

Introduction: Various prospective and retrospective studies have compared LCBDE and ESE àLC and reported similar morbidity, mortality and cost effectiveness. However, no literature exist regarding Quality of life (Qol) in these patients. The present randomized trial was undertaken to compare the outcome and Qol of patients undergoing treatment with these two approaches.

Materials and Methods: The study was conducted from 1st March 2013 to 31stMay 2015. 26patients were randomized to single stage laparoscopic CBD exploration with cholecystectomy (Group I) and 27 to ERCP followed by laparoscopic cholecystectomy (Group II). Diagnosis was confirmed preoperatively using MRCP and/or endoscopic ultrasound. Outcome measures included the Qol scores assessed via WHO BREF, EORTC QLQ c30 and HADS questionaires and pain scores.

Results: The demographic and clinical profiles were similar in both the groups. The average pain score on VAS scale was similar in both groups at 24 hours (p =0.4), at 1 week (p =0.35), and at 6 weeks (p = 0.2).Qol was similar in both groups with respect to psychological well being, environment and social relationships before and after intervention as assessed by WHO BREF. There was significant improvement in these domains post operatively (p<0.01).EORTC QLQ c30 also showed significant improvement in physical, emotional and role functioning in both the groups (p<0.01) with no intergroup variation pre or post procedure. Global health status was also similar in both groups post intervention. Symptom scales also showed substantial improvement in terms of nausea and vomiting. However, there were no significant complaints of insomnia, appetite loss or diarrhea.Both the depression and anxiety scores were comparable between the two groups preoperatively and at 3 months postoperatively. Two patients were diagnosed as borderline cases of depression, in ERCP → LC group. However, they recovered 3 months after surgery.

Conclusions: Single stage management of patients with gall stones and CBD stones is at par with two stage approach in terms of pain scores and quality of life scores.

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