Elective laparoscopic cholecystectomy for symptomatic uncomplicated gallstone disease: do the symptoms disappear?

BACKGROUND: Symptomatic gallstone disease is considered an indication for cholecystectomy. A considerable proportion of patients may experience persistent symptoms after surgery. The purpose of the present study was to find out the rate of symptom persistence after elective laparoscopic cholecystectomy (LC) performed for symptomatic uncomplicated gallstone disease and, in particular, to clarify whether the recurrence rate differs according to the severity of preoperative symptoms. METHODS: During a 10-year period (1992-2001), 1,101 patients underwent elective LC at Turku City Hospital for Surgery. A questionnaire concerning the intensity of preoperative symptoms, persistence of symptoms postoperatively, and overall satisfaction with the outcome of the procedure was sent to patients. A total of 677 patients [mean age (range) 59 (21-94) years; 554 (83.1%) females] with uncomplicated gallstone disease returned the completed form. RESULTS: Overall, 380 (57%) patients reported attacks of intense upper abdominal pain, and 287 (43%) reported episodic mild abdominal symptoms as the prevailing preoperative symptom. Two hundred and forty-eight (37%) patients continued to have abdominal symptoms after the operation. Among those with predominantly mild abdominal symptoms preoperatively, 119 (41%) reported the persistence of symptoms after the operation, while in the group with mainly severe upper abdominal pain attacks, 129 (33%) patients had recurrences (p = 0.052). CONCLUSIONS: According to our data, more than one-third of patients with symptomatic uncomplicated gallstone disease experienced persistent symptoms after elective LC. Patients with mild preoperative symptoms seemed to have more recurrences than those with severe symptoms, although the difference was not statistically significant.

Elective laparoscopic cholecystectomy: the effect of age on conversions, complications and long-term results.

BACKGROUND/AIMS: The purpose of the present study was to analyze the appropriateness and long-term results of elective laparoscopic cholecystectomy in the treatment of gallstone disease in the elderly. METHODS: We studied all elderly (≥75 years) patients (n = 80) who underwent laparoscopic cholecystectomy at our institution during the years 1992-2001. Two control groups (65-74 years and <65 years) included the same amount of patients. For determining the long-term results, we asked the patients to specify their overall satisfaction with the results of the procedure (very satisfied, satisfied, no effect, worse). RESULTS: There were no statistically significant differences in mean operative time (61, 65, 72 min) or conversions to open surgery (6, 11, 16%) between the age groups (<65, 65-74, ≥75 years). The mean hospitalization time (2.1, 3.3, 4.4 days) and complications (0, 11, 13%) increased with the age of the patients. Neither severe complications nor mortality were encountered. The vast majority of the patients were very satisfied or satisfied with the long-term results of the procedure in all age groups (97% <65 years, 83% 65-74 years, 80% ≥75 years). CONCLUSION: Elective laparoscopic cholecystectomy is also a safe and feasible operation with good long-term results in the elderly.