IS CHOLECYSTECTOMY EFFECTIVE TREATMENT FOR SYMPTOMATIC GALLSTONES - CLINICAL OUTCOME AFTER LONG-TERM FOLLOW-UP

The expectation that cholecystectomy is effective treatment for sympto matic gallstones is not always achieved in surgical practice. The impa ct of cholecystectomy on the relief of gastrointestinal symptoms was e valuated in 92 patients followed up after surgery for a mean of 31.1 m onths (range 12-83 months). Abdominal pain continued to be present, or arose de novo, in 28 (30.4%) patients. Pain-free outcome after cholec ystectomy was associated with a preoperative clinical diagnosis of bil iary colic, fatty food intolerance, and a thick-walled gallbladder on ultrasound (P=0.02). Logistic regression associated a thick-walled gal lbladder, elevated gamma-glutamyl transpetidase, body mass index <26, fat intolerance, and normal bowel habit with good postoperative result s (P=0.001). Application of each of these five factors to a clinical i ndex failed to predict long-term pain-free outcome after cholecystecto my. Abdominal bloating (P=0.03), dyspepsia (P<0.001), heartburn (P<0.0 07), fat intolerance (P<0.001), nausea (P=0.001) and vomiting (P<0.001 ) were significantly improved after cholecystectomy, but diarrhoea, co nstipation and excessive flatus were not. Outcome benefit ratios confi rmed that vomiting (0.96), nausea (0.87), dyspepsia (0.67), fat intole rance (0.57) and heartburn (0.51) were relieved by surgery. Cholecyste ctomy improved symptoms compared with a matched control group, suggest ing that surgery remains the gold standard treatment of symptomatic ga llstones.