Mills M, Sevensma K, Serrano J. Osteopathic Manipulative Treatment for a Recognizable Pattern of Somatic Dysfunction Following Laparoscopic Cholecystectomy. J Am Osteopath Assoc 2020;120(10):685–690. doi: https://doi.org/10.7556/jaoa.2020.111.
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Previous literature has demonstrated the prevalence and socioeconomic impact of postoperative pain in surgery patients. Somatic dysfunction has been demonstrated as a cause, but literature documenting osteopathic manipulative treatment (OMT) in surgery patients is lacking.
To describe typical patterns of and common treatments for somatic dysfunction in patients following laparoscopic cholecystectomy.
The authors retrospectively reviewed the billing records of all patients over 18 years of age who underwent laparoscopic cholecystectomy by a single surgeon and had postoperative outpatient OMT for right-side pain linked to somatic dysfunction between 2006 and 2018 at a community hospital in Grand Rapids, Michigan. Patients who underwent open cholecystectomy, who did not have documented somatic dysfunction, or had somatic dysfunction unrelated to their biliary disease were excluded.
Nine patients were selected for inclusion in this retrospective case series. All patients in the study demonstrated anterior right lower rib pain corresponding to posterior lower rib dysfunctions and rotated right and side-bent left thoracic spine dysfunctions between T5 and T11. Pain was successfully managed with muscle energy, high-velocity, low-amplitude, or soft tissue OMT.
Postoperative pain following laparoscopic cholecystectomy can be related to right-sided thoracic and rib dysfunctions. This is important for early diagnosis of surgical patients with somatic dysfunction and initiation of appropriate OMT to decrease morbidity related to pain, functional status, and quality of life.
Abbreviations: EF, ejection fraction; EGD, esophagogastroduodenoscopy; FPR, facilitated positional release; HIDA, hepatobiliary iminodiacetic acid scan; IOC, intraoperative cholangiogram; SD, somatic dysfunction, OMT, osteopathic manipulative therapy; RUQ, right upper quadrant; US, ultrasonography; WNL, within normal limits.
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