Outcome after cholecystectomy for symptomatic gall stone disease and effect of surgical access: laparoscopic v open approach.

Abstract

The pre and postoperative symptoms and outcome after surgery in patients with symptomatic gall stone disease were evaluated by a detailed self administered postal questionnaire. The survey was conducted in two groups: 80 patients treated by laparoscopic cholecystectomy and an age matched cohort of patients who had conventional open cholecystectomy. The overall response rate on which the data were calculated was 76%. Symptomatic benefit ratios accruing from the surgical removal of the gall bladder were calculated. The symptoms that were relieved by cholecystectomy were nausea (0.98), vomiting (0.91), colicky abdominal pain (0.81), and backpain (0.76). Flatulence, fat intolerance, and nagging abdominal pain were unaffected as shown by a benefit ratio of 0.5 or less. Relief of heartburn (39/49) outweighed the de novo development of this symptom after cholecystectomy (7/49), resulting in a benefit ratio of 0.65. Postcholecystectomy diarrhoea occurred in 21/118 patients (18%): 10 after open cholecystectomy and 11 after laparoscopic cholecystectomy. The type of surgical access did not influence the symptomatic outcome but had a significant bearing on the time to return to work or full activity after surgery (laparoscopic cholecystectomy two weeks, open cholecystectomy eight weeks, p = 0.00001). In the elderly age group (> 60 years), significantly more patients (29/30) regained full activity after laparoscopic cholecystectomy when compared with the open cholecystectomy group (16/22), p = 0.001. The patient appreciation of a satisfactory cosmetic result was 72% in the open group compared with 100% of patients who were treated by laparoscopic cholecystectomy (p = 0.0017). Despite the persistence or de novo occurrence of symptoms, 111/117 patients (95%) considered that they had obtained overall symptomatic improvement by their surgical treatment and 110/118 (93%) were pleased with the end result regardless of the access used.