E. Krombholz1, L. G. Collins1, W. Joyce1,2 1Galway Clinic,Surgery,Galway, Ireland 2Royal College of Surgeons,Dublin, Ireland
Introduction:
Right upper quadrant pain (RUQ) can persist after successful laparoscopic cholecystectomy (LC). This can cause patient distress and significant diagnostic and therapeutic challenges.
Methods:
A retrospective review of 210 consecutive patients undergoing cholecystectomy by a single surgeon was completed. Demographics, indication for procedure, type of procedure, final diagnosis and further treatment were reviewed. The presence and etiology of persistent RUQ post-operative pain was evaluated in this patient group.
Results:
The data of 210 patients was assessed. Conversion to open surgery was 4.4% (n=9). Planned open surgery was 1.9% (n=4). There were no postoperative deaths or major complications. 8.37% (n=17) of patients reported persistent RUQ pain post-operatively. Within this patient subgroup, 13 patients underwent LC and 4 patients underwent open surgery. The primary causes of persistent post-operative pain in this patient subgroup were musculoskeletal (53% ,n=9), neuropathic (12%, n=2), common bile duct stone (6%, n=1), and no cause found (12%, n=2).
Conclusion:
This study demonstrated that post-cholecystectomy pain syndrome is a real entity affecting 8% of this study cohort. The primary cause of post-operative pain was found to be musculoskeletal in origin. However for one patient in this cohort, the primary cause of pain was a common bile duct stone. Therefore, it is essential that post cholecystectomy patients with persistent RUQ pain are fully investigated to ensure that biliary pathology is not missed.