Laparoscopic cholecystectomy : Patient´s experiences and self-reported symptoms the first week after surgery

University dissertation from Stockholm : Karolinska Institutet, Department of Neurobiology, Care Sciences and Society

Abstract: Very little research has been conducted to identify patients own perspectives of having gallstone disease and their own experiences of symptoms the first postoperative week following laparoscopic cholecystectomy, LC. Although some randomized controlled studies comparing outpatient and inpatient LC have been performed previously, these studies have not in detail focused on LC patients recovery during the first week including symptom occurrence and distress following this procedure. The aim of study I was to explore patients experiences related to the gallstone disease and to their experiences of postoperative symptoms during the first week following outpatient LC. Twelve patients planned for LC in day surgery were interviewed one week after surgery and the data were analyzed with qualitative analysis (I). The findings showed that respondents with gallstone disease prior to surgery not only experienced limitations in their daily life but also had feelings of being socially handicapped. Prior to surgery the patients felt anxious and expressed a wish for tranquilizers, as well as asking to meet the responsible surgeon. At discharge after day surgery, amnesia was experienced and the respondents did not remember important information about the operation given by the surgeon. Further, the experience of postoperative pain varied greatly and several respondents had a relapse of pain on the third day lasting up to one week. The respondents expressed a need for additional pain medication. Feelings of abdominal bloating were reported as well as nausea and vomiting and questions about wound care were raised. The need for additional telephone follow-up was expressed and it was felt difficult to come home to small children. However, returning home on the day of surgery was a positive experience. In study II, the main aim was to compare certain aspects of the two treatment modalities outpatient and inpatient LC. The aspects being studied were: the patients perceptions of pain and other postoperative symptoms, and the amount of distress these symptoms caused. A secondary aim was to compare the patients pre and postoperative levels of anxiety and general health during the first postoperative week after surgery (II). Out of 100 patients who were randomized to either LC in outpatient or inpatient surgery, 73 were valid for efficacy and responded to questionnaires regarding pain and other postoperative symptoms, anxiety and perceived health. The main result from study II showed no significant differences between the outpatient (n=34) and the inpatient (n=39) groups regarding the occurrence of post-operative symptoms except from a slightly higher frequency of reduced mobility (outpatients day 1) and sleeping disturbances (inpatients day 7). Approximately 90% of the patients in both groups perceived pain, reduced mobility and tiredness on postoperative day 1. Nausea and loss of appetite were reported by half of the patients. As regards symptom distress, no differences were found between the groups. Approximately 40% of the patients reported much/very much distress related to pain and reduced mobility postoperative day 1 and distress related to nausea was reported by 20% of the patients in both groups. Although both groups reported fewer symptoms on day 7, one third still experienced pain. The perceived degree of anxiety among our patients decreased significantly in both groups during the first postoperative week and the perceived levels of general state of health was in both groups back to preoperative status after one week. In conclusion, patients undergoing LC surgery expressed a number of problem areas and reported a high frequency of postoperative symptoms. Therefore, it is important to make assessments of the patients own perceptions in order to optimize postoperative care. Patients undergoing LC in outpatient surgery recovered equally well as patients undergoing LC as inpatients, thus a greater proportion of LC patients should be offered the outpatient modality.

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