Surgical referral for cholecystectomy in patients with atypical symptoms

Am J Surg. 2020 Dec;220(6):1451-1455. doi: 10.1016/j.amjsurg.2020.10.016. Epub 2020 Oct 19.


Background: Cholelithiasis referrals often present with concomitant or isolated atypical symptoms such as reflux, bloating, or epigastric pain. We sought to identify the impact of preoperative symptomatology of atypical or dyspepsia-type biliary colic on operative and non-operative clinical outcomes.

Methods: A retrospective review of patients referred for gallstone disease from 2014 to 2018 at a single institution in Los Angeles County was performed.

Results: Of 746 patients evaluated for gallstone disease, 87.4% (n = 652) underwent cholecystectomy - 90.8% (n = 592) had symptom resolution postoperatively whereas 9.2% (n = 60) did not. Over half presented with concomitant atypical and/or dyspepsia symptoms (n = 411). Heartburn/reflux was significantly associated with unresolved symptoms postoperatively (OR 2.1,1.0-4.4, p = 0.04). Overall, 11.1% (n = 83) of all 746 patients and 20.2% of patients with atypical and/or dyspepsia symptoms improved with medical management of gastritis or Helicobacter pylori triple therapy pre/post-operatively.

Conclusion: Atypical biliary colic and/or dyspepsia is associated with unresolved symptoms following cholecystectomy. Such patients may benefit from H. pylori testing or PPI trial prior to cholecystectomy.

Keywords: Atypical biliary colic; Cholecystectomy; Dyspepsia; Helicobacter pylori.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Cholecystectomy*
  • Dyspepsia / complications
  • Female
  • Gallstones / surgery*
  • Gastritis / complications
  • Helicobacter Infections / complications
  • Helicobacter pylori
  • Humans
  • Male
  • Middle Aged
  • Referral and Consultation / statistics & numerical data*
  • Retrospective Studies