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Dr. Sreedevi* Dr. Santhaseelan Dr. Hema Vijayalakshmi V ABSTRACT KEYWORDS INTERNATIONAL JOURNAL of SCIENTIFIC RESEARCH

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Dr. Sreedevi* Dr. Santhaseelan Dr. Hema Vijayalakshmi V ABSTRACT KEYWORDS INTERNATIONAL JOURNAL of SCIENTIFIC RESEARCH ORIGINAL RESEARCH PAPER Volume-8 | Issue-11 | November - 2019 | PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH EVALUATION OF UGI SCOPY FINDINGS FOR PRE- ELECTIVE LAPAROSCOPIC CHOLECYSTECTOMY TO PREVENT POST CHOLECYSTECTOMY SYNDROME General Surgery Dr. Ankush Misra Department Of General Surgery, Sree Balaji Medical College And Hospital, Chennai. Professer, Department Of General Surgery, Sree Balaji Medical College And Hospital, Dr. Sreedevi* Chennai. * Corresponding Author Professer, Department Of General Surgery, Sree Balaji Medical College And Hospital, Dr. Santhaseelan Chennai. Dr. Hema Department Of Medical Gastroenterology, Sree Balaji Medical College And Hospital, Vijayalakshmi V Chennai. ABSTRACT Background: Laparoscopic cholecystectomy is gold standard surgery for symptomatic gall stone disease which is the commonest disease needs surgical management. Symptomatology of the patients having upper GI pathologies can mimick the symptomatic gall stone disease and vice versa. Though biliary colic is specific for gallstones. Patients presenting with other gastrointestinal symptoms can also have gall stones. In this study UGI endoscopy was done for all patients with symptomatic and investigation proved gall stone disease to rule out other pathological causes of gastrointestinal tract and prevent post cholecystectomy syndrome. Methods: Patients with Ultrasonography suggestive of single or multiple gall stones were included. Upper GI Scopy was done prior to laparoscopic cholecystectomy as per inclusion and exclusion criteria. All patients above 18years, with ultrasonographically proven diagnosis of cholelithiasis Results: In present study, 153 patients were included. Pain in abdomen was present in 88.2% of patients. Nausea/vomiting was second most common symptom and seen in 60.78%. It is also seen that OGD findings were abnormal in 108 patients (i.e.70.58%) and OGD findings were normal in 45 patients. The patients with abnormal ODG findings were subjected to pre op treatment of the respective GI pathology. Hence after Lap Cholecystectomy , post operatively patients were highly satisfied and relieved of their symptoms Conclusions: Cholecystectomy can be curative only whose symptoms are due to gallstones, and not due to other upper GI pathologies. Approach of performing OGD as a routine investigation prior to cholecystectomy, will decrease persistence of symptoms and prevent post-cholecystectomy syndrome. KEYWORDS Cholelithiasis, UGI Scopy INTRODUCTION commonly performed abdominal surgical procedure for cholelithiasis, Laparoscopic cholecystectomy is gold standard surgery for biliary dyskinesia, acute cholecystitis, calcified gall bladder, gallstone symptomatic gall stone disease which is the commonest disease needs pancreatitis, choledocholithiasis etc. surgical management. It causes unnecessary burden of cost and surgical risk to patient, it also delays definitive treatment for the actual Some patients do not get symptomatic relief or get only partial relief cause.1 after laparoscopic cholecystectomy as symptoms are not entirely due to cholelithiasis. Symptomatology of upper GI diseases can be The pain due to the obstructing stone causes sudden expansion of the overlapping so upper gastrointestinal endoscopy is important to 2 gall bladder called “Biliary Colic”. This typical pattern of pain occurs identify the diseases of upper gastrointestinal tract as it evaluates the at right upper quadrant or epigastric region and lasts for 15 minutes to esophagus, stomach and duodenum along with direct visualization of several hours after a fatty meal. When pain gradually disappears, it the ampulla of Vater. It is considered a minimally invasive procedure usually leaves behind a dull ache with nausea and vomiting. As the and does not require any significant recovery after the procedure as it is supply is splanchnic nerve, pain radiates to right scapula or shoulder tip performed under local anesthesia in our institution. and occasionally to back. 80% of patients with cholelithiasis are 3-6 asymptomatic. Most studies show that patients appear to be Gallstones found incidentally in the investigation of gastrointestinal symptomatic at 2% to 3% yearly. Among them 2% have an overall risk symptoms may become falsely attributed to explain pathology that of biliary complications such as acute pancreatitis and acute arises outside the biliary tree.11 The majority of patients presenting with choledocholithiasis and 0.02% have the risk of incidence of upper abdominal pain undergo ultrasound examination and on gallbladder cancer. Among symptomatic patients, 50% develop biliary detection of gallstones, the main focus of the attending clinician stays colic within a year. Though biliary colic is specific for gallstones, most around treating the gallstones and further investigations to rule out patients are present with other abdominal symptoms. other pathologies that may produce similar symptoms are not considered and surgery is often performed inappropriately. The term “symptomatic gallstones” is widely used to describe symptoms arising secondary to gallstones. The symptoms of gallstones are variable ranging from nonspecific to acute medical Persistent post cholecystectomy pain has been reported in a proportion emergency. Wide range of gastrointestinal symptoms that have been of patients called as “post cholecystectomy syndrome”. Post- linked to gallstones, but causal relationship has not been established. 7 cholecystectomy syndrome (PCS) consists of a group of abdominal symptoms that recur and/or persist after cholecystectomy. It is defined as early if occurring in the post-operative period and late if it manifests Symptoms that does not fit typical pain criteria is considered as 12 atypical and include any abdominal discomfort, dyspepsia, nausea, after months or years. Although this term is used widely, it is not belching, heart burn, food intolerance, flatulence, vomiting, loss of completely accurate, as it includes a large number of disorders, both appetite.8 Sometimes, patients have mixture of atypical upper GI biliary and extra-biliary in origin that may be unrelated to symptoms and discovered to have gallstones on imaging studies. The cholecystectomy. latter group are likely to be associated with poor symptomatic outcome. 9 Approach of performing OGD as a routine investigation prior to cholecystectomy, will decrease persistence of symptoms and will help It is commonly accepted that removal of the gallbladder is the best in detecting gastroduodenal pathologies at an early stage and prevent treatment for symptomatic gallstone disease.10 Cholecystectomy is a pcs. 58 International Journal of Scientific Research Volume-8 | Issue-11 | November - 2019 PRINT ISSN No. 2277 - 8179 | DOI : 10.36106/ijsr Many patients of upper gastrointestinal problems with gallstones have esophagitis, gastritis, peptic ulcer disease and hiatus hernia may attribute to the post cholecystectomy syndrome.13,14 The challenge in the evaluation of patients with upper gastrointestinal symptoms, who also have gallstones, is to decide whether gallbladder stones are the source of the symptoms or an incidental finding and differentiating is important, as both conditions are common. The persistence of abdominal symptoms after laparoscopic cholecystectomy patients is due to inadequate preoperative evaluation of other conditions that causes the same symptomatology. Thus, this Table 4 – Number of patients with normal/deranged Liver study was conducted to contribute UGI endoscopy as routine Function Test preoperative investigation and the importance of UGI endoscopy to NORMAL BILIRUBIN ABNORMAL BILIRUBIN evaluate the association between gastrointestinal symptoms with 114 39 gallstones and reduce the prevalence of post cholecystectomy pain. Table 5 - Ultrasonography findings for all the cases. METHODS FINDINGS NUMBER This prospective study is carried out in the department of general SOLITARY STONE 48 surgery in our institute. 153 patients attended to in surgical wards, MULTIPLE STONES 105 outpatient and emergency department were included. Patients presenting with complaints of right hypochondriac region, epigastric SIZE - <5mm 33 pain and with upper GI symptoms were assessed. All patients with 5-10mm 69 history suggestive of gall bladder diseases were evaluated and >10mm 51 investigated. Abdominal ultrasonography was performed at the time of THICKENED GB WALL 72 admission by well qualified, experienced radiologists. Patients with CBD ABNORMAL 9 ultrasonography suggestive of single or multiple gall stones were Table 6 - UGI Scopy Findings as observed by Gastro-Enterologist included and investigated. Upper GI scopy was done 1 to 2 days prior FINDINGS NUMBER to laparoscopic cholecystectomy as per inclusion and exclusion EROSIVE GASTRITIS 72 criteria. OESOPHAGITIS 15 ANTRAL EROSIONS 9 All patients above 18 years, with ultrasonographically proven CONGESTIVE GASTROPATHY 6 diagnosis of cholelithiasis and with symptoms (typical and atypical) were included. Patients not willing to provide written, informed LAX LES 2 content, patients below 18 years, patients with acute abdomen, whose CORPAL/FUNDAL EROSIONS 1 general conditions were not stable, cholangitis, gall stone pancreatitis, DUODENAL ULCER 1 cholecystoenteric fistula, gall bladder neoplasm, with past history of NORMAL STUDY 45 previous biliary/pancreatic surgery, refusing for surgery and/or upper gastrointestinal endoscopy were excluded. Pre-operative data was reassessed. Informed written consent was taken with
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