LONG-TERM RESULTS AFTER LAPAROSCOPIC CHOLECYSTECTOMY

As part of a continuing audit of patients undergoing laparoscopic chol ecystectomy (which now numbers over 1500) 468 of the 508 patients (92. 1 per cent) operated on between October 1989 and March 1991 were studi ed between 350 and 988 days after the operation (mean 19 months). A qu estionnaire was filled in by each patient before operation and at the late follow-up visit. Eight specific symptoms were sought - non-colick y pain, colic, abdominal distension, nausea, vomiting, loss of appetit e, flatulence, and dietary restriction. The result of each operation w as assessed by two surgeons and by the patient. In 453 patients (96.8 per cent) the symptoms had improved as a result of the operation, but 260 patients (55.6 per cent) had some abdominal symptoms. The result w as assessed as excellent in 310 patients (66.2 per cent); 143 (30.5 pe r cent) still had abdominal complaints but they were willing to cope w ith those symptoms. In 15 patients (3.2 per cent) the result was unsat isfactory. Statistical analysis of 26 preoperative variables showed fe w significant differences between patients with excellent results and patients with persisting or new symptoms. The percentage of patients w ith biliary colic was reduced from 82.9 per cent before to 6.4 per cen t after laparoscopic cholecystectomy (P<0.05), and of those with flatu lence from 62.6 per cent to 45.3 per cent (P<0.05). Flatulence persist ed in 147 (50.2 per cent) of the 293 patients who had complained of fl atulence before the operation, and of the 175 patients who had not com plained of flatulence before surgery, 65 (37.1 per cent) reported the symptom for the first time after the operation. It appears that 'flatu lent dyspepsia' after cholecystectomy has many causes, one of which ma y be removal of the gallbladder. It is concluded that the long-term re sults of laparoscopic cholecystectomy in patients with symptomatic gal lstone disease were excellent but the prognosis in individual patients was unpredictable.