Possibilities of Using the Gastrointestinal Quality of Life Index in Evaluating the Results of Surgical Treatment of Patients with Calculous Cholecystitis

The dissertation is devoted to evaluating the possibilities of applying the Gastrointestinal Quality of Life Index (GIQLI) for analyzing the results of surgical treatment of patients with calculous cholecystitis. The study compares conventional and laparoscopic cholecystectomy, with quality of life dynamics assessed at 3, 6, and 12 months after surgery. The research demonstrates that GIQLI enables comprehensive staged evaluation of quality of life in patients operated on by both methods.

The results show that three months after surgery, patients in the main group exhibited a significant predominance of the gastrointestinal quality of life index; by six months the difference between groups decreased, and by one year, no substantial difference in quality of life was found between the conventional and laparoscopic cholecystectomy groups. The proposed questionnaire facilitates timely diagnosis and correction of postoperative complications, which can significantly improve surgical treatment outcomes.

Relevance of the topic.

Gallstone disease is one of the most common diseases of the human digestive system [78]. Large-scale epidemiological studies conducted in economically developed countries of Western Europe and North America have shown that nearly 30% of the white population suffers from gallstone disease [80]. Despite the emergence of conservative methods of treating patients with gallstone disease such as extra- and intracorporeal shock wave lithotripsy, the latest developments in litholytic therapy, etc., the surgical method remains the leading and sufficiently pathogenetically justified [34,35,36,85].

Until the mid-1980s, the primary method of surgical treatment for chronic calculous cholecystitis remained conventional cholecystectomy performed via a wide laparotomy approach [59,77].

However, the main drawback of this method is significant surgical trauma, which leads in the postoperative period to restricted mobility of the anterior abdominal wall, pain syndrome, and deterioration of respiratory function indicators [46,74,77]. These circumstances delay the process of labor and social rehabilitation for this patient contingent by 2-3 months, and sometimes longer.

A new era in the development of gallstone surgery was marked by the introduction into widespread practice in the late 1980s of laparoscopic cholecystectomy. It is currently widely recognized that laparoscopic cholecystectomy is the «gold standard» in the treatment of patients with gallstone disease, and it is widely used in many clinics around the world [10,18,25,4]. It should be noted that these procedures are not feasible for all patients; there are both indications and specific contraindications for performing laparoscopic operations [33,77,1].

The planned study does not aim to characterize the superiority of laparoscopic operations over open ones; there are numerous publications in the scientific literature on this matter [33,1].

The work is aimed at studying and improving methods for evaluating the results of treatment performed. Until recently, many authors evaluated long-term outcomes of surgical treatment using various classifications and scales, the most widespread of which is the repeatedly modified Büh scale. Results were based on clinical and instrumental data and were rated as excellent, very good, satisfactory, and unsatisfactory. At the same time, the fact that for each patient it is of great importance not only the dynamics of disease symptoms, laboratory and instrumental test results, but also the achievable level of satisfaction with one's physical, mental, and social state [39,103,129,135,197] was often overlooked.

Health-related quality of life is an integral characteristic of the physical, psychological, emotional, and social functioning and/or state of a healthy or sick person, based on their subjective perception.

Currently, abroad, the study of quality of life index is a priority direction, and the method is widely used to evaluate the results of not only surgical but also conservative, and often symptomatic treatment.

In domestic literature, a small number of articles have been published devoted to studying the quality of life index in patients after surgery, and in particular, after cholecystectomy.

This circumstance makes the study of this direction in surgery relevant, through comprehensive dynamic analysis using a specialized questionnaire.

Aim of the study.

To determine the possibilities of using the Gastrointestinal Quality of Life Index (GIQLI - Gastrointestinal Quality of Life Index) in evaluating the results of surgical treatment of patients with calculous cholecystitis.

Tasks of the study.

1. To study the quality of life of patients with chronic calculous cholecystitis before surgery using the GIQLI questionnaire.

2. To trace the dynamics of the gastrointestinal quality of life index (GIQLI) in patients after open and laparoscopic cholecystectomy at 3, 6, and 12 months after surgery.

3. Using the gastrointestinal quality of life index questionnaire (GIQLI), to identify postoperative complications and analyze their impact on the quality of life level of patients after conventional and laparoscopic cholecystectomy.

4. To determine the role of quality of life parameters in evaluating the results of surgical treatment.

Scientific novelty.

This study demonstrates an example of working with the proposed GIQLI questionnaire for reliable evaluation of surgical treatment outcomes in patients with gallstone disease.

The questionnaire makes it possible to conduct a comprehensive staged assessment of quality of life in patients operated on for calculous cholecystitis by conventional and laparoscopic methods.

Three months after surgical treatment, using the questionnaire, a significant predominance of the gastrointestinal quality of life index was established in the main group of patients; at 6 months, the difference in the gastrointestinal quality of life index between patient groups decreased. The achievable level of well-being at 1 year after surgery indicates the absence of a significant difference in the quality of life of patients after conventional and laparoscopic cholecystectomy.

The proposed GIQLI questionnaire contributes to timely diagnosis and correction of postoperative complications, which makes it possible to significantly improve the results of surgical treatment of patients with calculous cholecystitis.

It is recommended to widely implement the quality of life index as an additional integral indicator of treatment efficacy for patients in general surgical hospitals.

Practical significance of the work.

Monitoring quality of life indicators in patients with chronic calculous cholecystitis using the GIQLI questionnaire allows for a more multifaceted evaluation of the results of treatment performed and enables the identification and prevention of postoperative complications.

An advantage of laparoscopic cholecystectomy over the conventional method was found at 3 months, which diminishes at 6 months and is absolutely indistinguishable one year after surgical intervention.

The gastrointestinal quality of life index (GIQLI) allows for timely diagnosis and correction of postoperative complications, which makes it possible to significantly improve the results of surgical treatment of patients with calculous cholecystitis.

Main findings to be defended:

1. The subjective condition of patients after surgery is one of the most important components, which reflects the effectiveness of treatment regimens in a more multifaceted manner. Quality of life index indicators can more reliably reflect the effectiveness of surgical treatment regimens for calculous cholecystitis.

2. A questionnaire incorporating the characteristics of the gastrointestinal quality of life index (GIQLI) has been proposed, which made it possible to conduct a staged assessment of quality of life in patients operated on for calculous cholecystitis by conventional and laparoscopic methods.

3. Three months after surgical treatment, a significant advantage of the gastrointestinal quality of life index was found in the main group of patients; at 6 months, a reduction in the difference in the gastrointestinal quality of life index between patient groups is observed. The achievable level of well-being at 1 year after surgery indicates the absence of a significant difference in the quality of life of patients after conventional and laparoscopic cholecystectomy.

4. The use of the gastrointestinal quality of life index (GIQLI) allows for timely diagnosis and correction of postoperative complications, which makes it possible to significantly improve the results of surgical treatment of patients with calculous cholecystitis.

Implementation of research results in practice.

The data obtained as a result of the conducted work found wide application in the surgical departments of Moscow city clinical hospitals No. 33 named after Prof. A. A. Ostroumov, No. 40, and the Central Clinical Hospital of the Central Council of Trade Unions of the Russian Federation.

The main findings of the dissertation are used in lectures and practical exercises at the Department of Hospital Surgery of MSMSU.

I express sincere gratitude and appreciation to the head of the Department of Hospital Surgery of the Moscow State Medical and Dental University, Corresponding Member of the RAMN, Honored Scientist of the Russian Federation, Doctor of Medical Sciences, Prof. I. V. Yarema, the scientific supervisor Doctor of Medical Sciences B. S. Kornyak, all employees of the department and GKB No. 33, 40 for their help and support in writing the dissertation.

Defense of the work.

The main findings of the dissertation work were reported and discussed at:

• The All-Russian Scientific and Practical Conference of Surgeons dedicated to the 85th anniversary of the Astrakhan Surgical Society, Astrakhan, September 2006;

• The Interdepartmental Scientific and Practical Conference of the Departments of Hospital Surgery, Operative Surgery and Topographic Anatomy, Anesthesiology and Reanimatology, Disaster Medicine, Pathological Anatomy, the Laboratory of Clinical and Experimental Surgery of the OKM NIMSI of Moscow State Medical and Dental University, the Laboratory of Clinical Lymphology of the Russian Medical Academy of Postgraduate Education, September 30, 2006. academy

Volume and structure of the dissertation.

The dissertation consists of an introduction, a literature review, 2 chapters of original research, a conclusion, findings, practical recommendations, and a reference list including 94 domestic and 120 foreign works. The dissertation text is written on 117 typewritten pages, illustrated with 9 tables and 28 diagrams.