Comparative Pateint Reported Well Being After Laparoscopic Cholecystectomy Performed with or Without Energised Dissection-A Case Controlled Study

Objective of Study
Post-operative pain, fatigue, circadian disturbances & well-being are cardinal patient reported outcome (PRO) measures indicating desired/ expected Health related Quality of Life (HrQoL) improvement after Laparoscopic Cholecystectomy (LC). These PROs result from a cascade of inflammatory and metabolic stress responses to surgery. Energised dissection (ED) in LC may excite these inflammatory & stress pathways as ED isn’t physiologically inert. We studied the effect of ED on PROs after LC.
Methods and procedures
Consecutive unselected candidates for day care LC (March 2007-Feb 2009) were enrolled following Ethics/ Informed Consent Protocol to be allocated to Study group i.e. LC without ED (LC-ED; those consulting us in the morning clinic) and the Control Group i.e. LC with ED (LC+ED; those consulting us in the evening clinic). A standard anesthesia / antibiotic/ analgesia / surgery & discharge protocol was followed.

Study End Point Measuring Scale
HrQoL 100-point; 36-items;8-subscale SF-36 generic measure
Nausea 0-no nausea; 1-some; 2-moderate; 3-severe; 4-vomiting
Pain no pain-worst @100 point visual analog scale (VAS)
Sleep Quality worst – best sleep @ 0-100-mm VAS-assessed at 8am.
Well Being 100-mm VAS-assessed in evening at 8pm.
Discharge Willingness 4 point Likert scale i.e.1-donot want to go; 2-will go if all is definitely well; 3-will go if doctor insists; 4-want to go
Fatigue 10-point Christensen fatigue scale; 1 = fit, 10 = fatigued

Prospective data collected pre-operatively (P0) & post-operatively on Day1 (D1), Day2 (D2), Day3 (D3), 1st week (W1), 2nd week (W2) & 3rd week (W3).

The Study (53) & Control (93) groups were well matched for demographic, activity, co-morbidity and gallbladder inflammation parameters. There were no adverse events or failure to discharge from day care although control group patients were extremely reluctant. Patient noncompliance led to withdrawal of 9 & 17 patients leaving 44 (study) & 76 (control) for analysis. Only patients of LC+ED reported right sided scapulo-costal & shoulder tip pain predominating up to D3, patients of LC-ED didn’t report this at all.

Post-operative mean scores

Follow-up D1
D2 D3
D3 W1
W1 W3
Control (LC+ED) 3 2 0.5 66 40 20 10 9 4
Study (LC-ED) 1.5 0.5 0 42 21 18 6 3 1.2
Mean Scores- Sleep, Well-being & Discharge Willingness

Sleep Quality
General Well-Being



D1 D2 D3 D3 W1
Control (LC+ED) 22 45 60 50 60 82 1.8
Study (LC-ED) 28 70 90 70 84 94 3.6

Mean HrQoL scores*–Control (Study)

P0 80(90) 70(75) 60(60) 66(65) 55(60) 45(65) 80(75) 80(78)
W1 60(80) 35(65) 60(80) 70(90) 45(65) 50(90) 80(80) 80(80)
W3 65(85) 45(70) 90(95) 75(95) 55(65) 70(95) 80(80) 80(80)

*PF-physical functioning; RP-role physical; BP-bodily pain; GHP-general health perception; VI-vitality; SF-social functioning; RE-role emotional; MH-mental health

Patient reported outcomes are better after laparoscopic cholecystectomy without energized dissection benefitting the global sense of well being.

Session: Poster

Program Number: P421

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