20 TO 30 YEAR FOLLOW-UP AFTER CHOLECYSTECTOMY

Background/Aims: We studied retrospectively the need for re-examinatio ns and re-operations, the development of alimentary tract cancer, and the occurrence of abdominal symptoms 20-30 years after elective cholec ystectomy. Material and Methods: Between 1963 and 1973 296 patients (7 3 males and 223 females) were treated by cholecystectomy. The indicati on was biliary colics plus stones in gallbladder. Patients with biliar y-enterostomy, sphincteroplasty or synchronous extrabiliary operations were excluded. Retained bile duct stones were excluded by cholangiogr aphy. Medical records of all patients, death certificates of the patie nts who had died during the follow-up (n = 74), and the autopsy findin gs of autopsied patients (n = 29) were reviewed. The living 220 patien ts were interviewed by a structured questionnaire a median of 26 years after the operation. Results: Patients were divided into two groups: Group I (172 patients) underwent cholecystectomy only and Group II (12 2 patients) underwent cholecystectomy and common duct stone extraction . During the follow-up, 25 patients (9%) underwent examination for bil iary colics and 12 (4%) were re-operated, 10 during 1-5 years after ch olecystectomy. Both the examinations and re-operations were more commo n in Group II than in Group I (p<0.005). Eight patients developed alim entary tract cancer during the follow-up. Thirty-nine per cent of pati ents reported abdominal symptoms, 20% having had these already prior t o cholecystectomy. Abdominal pain was reported by 21%, distention by 2 0%, heart burn 16%, obstipation 14%, and diarrhea by 11%. Abdominal pa in and diarrhea occurred more frequently in Group I than in Group II. Conclusion: Recurrent biliary colics and stones in the common bile duc t are extremely rare later than five years after cholecystectomy and a re not expected unless the patients have also initially had common duc t stones. One third of patients suffer from other abdominal symptoms.