Laparoscopic cholecystectomy : Patients experiences of self-reported symptoms, perception of health and sense of coherence in a short and long term perspective

University dissertation from Stockholm : Karolinska Institutet, Department of Clinical Sciences

Abstract: The aim of Study I was to explore patients experiences related to gallstone disease and to their experiences of postoperative symptoms during the first week following outpatient laparoscopic cholecystectomy (LC). Twelve patients treated in day surgery were interviewed one week after surgery and a qualitative analysis was performed. A number of symptoms were expressed, e.g. preoperative anxiety, postoperative amnesia, experience of pain, need for additional pain medication, feelings of nausea and difficulties having small children at home. In a randomized study (II), the aim was to compare the two treatment modalities, outpatient and inpatient LC, the first postoperative week. Seventy three patients answered questionnaires concerning perceptions of pain and other postoperative symptoms, the amount of distress these symptoms caused and the levels of anxiety and general health during the first postoperative week after LC surgery. The result showed no significant differences between the outpatient (n=34) and the inpatient (n=39) groups regarding the occurrence of postoperative symptoms except from a slightly higher frequency of reduced mobility (outpatients day 1) and sleeping disturbances (inpatients day 7). In Study III the progress of recovery up to 6 months following LC was investigated, as well as sex differences. The above-mentioned questionnaires were repeatedly answered by the 73 patients up to six months following surgery. Patients perception of health improved over time, especially depending on increased physical well-being between day 7 and 1 month. Symptom occurrence and symptom distress decreased rapidly during the first postoperative week. However, 30% of the patients reported at least one distressful symptom at 6 months. In Study IV, the aim was to investigate predictors of average pain the first postoperative week (VAS-mean) and changes in Health Index (HI) following LC with special reference to Sense of Coherence (SOC). Except for the questionnaires above, the 73 patients also completed the SOC scale preoperatively and at 6 months. By multiple regressions, 29% of the variability in VAS-mean could be explained by the variables age, HI and education. Further, 19% of the variability in HI improvement between day 7 and 1 month could be explained by symptom distress day 1 and the SOC (preoperative value). SOC was found to be a weak but significant predictor of health improvement and pain after LC. Patients scoring low SOC regained health later than patients scoring high SOC.

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