INCIDENCE OF PERSISTENT SYMPTOMS AFTER LAPAROSCOPIC CHOLECYSTECTOMY -A PROSPECTIVE-STUDY

Background and Aims-Laparoscopic cholecystectomy is the standard treat ment for symptomatic gall stone disease. This study aimed to assess th e effect of the operation on patients' symptoms. Methods-One hundred c onsecutive patients undergoing laparoscopic cholecystectomy between Ju ne 1994 and June 1995 were evaluated using standard questionnaires exa mining demographic details, indication for laparoscopic cholecystectom y, characteristics of pain, and other associated dyspeptic and colonic symptoms. A history of psychiatric disturbances and of hysterectomy w ere also recorded. The same questionnaires were administered again six months after the operation. Operation notes and histological reports were reviewed. Results-Three patients were converted to open surgery a nd were excluded from analysis. The median age of the remaining 97 pat ients was 50 . 9 (19-85) years; 19 were men. There was one complicatio n each of bleeding and biliary leak. Indications for laparoscopic chol ecystectomy were biliary type pain (66 patients) and complicated gall stone disease (acute cholecystitis 21, cholestatic jaundice six, and p ancreatitis four). Thirteen patients (13%) had persistent pain and two (3%) developed diarrhoea at follow up. Only one patient with persiste nt pain after laparoscopic cholecystectomy originated from the complic ated gall stone disease group. Logistic discriminant analysis showed t hat bloating (p<0 . 001), constipation (p<0 . 05), and previous and cu rrent use of psychotrophic drugs (p<0 . 001) were significantly more c ommon among those with a poor outcome after laparoscopic cholecystecto my. Heartburn was unaffected. Of patients with persistent symptoms aft er cholecystectomy 77% had no or mild histological changes of cholecys titis as compared with 30% in the pain free group. Conclusions-The inc idence of persistent pain after laparoscopic cholecystectomy was 13%. Abdominal bloating and psychiatric medications were predictive for per sistence of pain after laparoscopic cholecystectomy.