Prophylactic cholecystectomy in individuals with spinal cord injury: A systematic review

The Journal of Spinal Cord Medicine, 2023 · DOI: 10.1080/10790268.2022.2144026 · Published: July 1, 2023

Simple Explanation

Individuals with spinal cord injury (SCI) frequently experience gastrointestinal issues, including a higher incidence of gallstones. This can lead to more complex and difficult to diagnose cases of gallbladder disease. Some medical centers advocate for preventive gallbladder removal (prophylactic cholecystectomy) in SCI patients with gallstones, assuming it will prevent future complications. However, it is unclear if there is sufficient evidence to support this practice. This review systematically assesses the available research on prophylactic cholecystectomy in individuals with SCI and gallstones to determine the quality and strength of evidence supporting this intervention.

Study Duration

Not specified

Participants

Four retrospective observational studies

Evidence Level

Level III-2 Retrospective Observational Studies

Key Findings

1
The literature search identified only retrospective observational studies, with no prospective cohort studies comparing prophylactic cholecystectomy to conservative management in individuals with SCI and gallstone disease.
2
Operative times, conversion rates, estimated blood loss, severity of complications, morbidity, and mortality did not significantly differ between individuals with SCI and neurologically able individuals.
3
Asymptomatic cholecystectomy was performed in 4–16.5% of the participants.

Research Summary

This systematic review aimed to evaluate the evidence supporting prophylactic cholecystectomy in individuals with SCI and cholelithiasis. The review analyzed studies identified from Medline, Cochrane, and Web of Science databases up to July 10, 2022. The review found that only retrospective observational studies were available, with no prospective cohort studies comparing prophylactic cholecystectomy with conservative management. These studies indicated that individuals with SCI had a higher prevalence of gallstone disease. The authors concluded that there is no robust evidence to support prophylactic cholecystectomy in individuals with SCI and gallstone disease, and further studies are needed to investigate its merits.

Practical Implications

Need for Further Research

Highlights the necessity for prospective studies to compare prophylactic cholecystectomy with conservative management in SCI patients with gallstone disease.

Cautious Approach

Suggests a cautious approach to prophylactic cholecystectomy in SCI patients due to the lack of strong evidence supporting its benefits.

Clinical Decision Making

Encourages clinicians to carefully consider the limited evidence base when making decisions about prophylactic cholecystectomy in SCI patients, emphasizing the need for individualized assessments.

Study Limitations

1
Inclusion of only retrospective observational studies.
2
Small sample sizes in the included studies.
3
Inability to avoid duplication of patients across studies due to the use of databases from VAMC institutes in overlapping years.

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