Long-term pain: Less common after laparoscopic than open cholecystectomy

Abstract

Persistent symptoms after cholecystectomy are common, occurring in up to 40 per cent of patients. Severe pain persists in 10 per cent of cases. A total of 450 patients were studied, 200 after open cholecystectomy and 250 after the laparoscopic operation. Patient notes were reviewed and a postal questionnaire was circulated. Responses were obtained from 155 patients (77.5 per cent) undergoing open cholecystectomy and 205 (82.0 per cent) having the laparoscopic operation. Mean (s.d.) follow-up was 32(23) months after open cholecystectomy and 15(7) months after the laparoscopic procedure. Right upper quadrant pain was more common after open cholecystectomy (9.7 versus 3.4 per cent, P < 0.05). Indigestion and heartburn were equally prevalent in the two groups. Some 59.4 per cent of patients were free from symptoms after open cholecystectomy compared with 63.4 per cent following the laparoscopic operation; there was symptomatic improvement in 30.3 and 31.7 per cent respectively. Symptoms were the same or worse in 10.3 per cent of patients after open cholecystectomy compared with 4.9 per cent after the laparoscopic operation (P < 0.05). Patients report significantly less right upper quadrant pain after laparoscopic than after open cholecystectomy.

Comparison of long-term quality of life after laparoscopic and open cholecystectomy

“…In McMahon's [7] study, the only difference in gastrointestinal symptoms between LC and OC was that significantly fewer patients who underwent LC reported heartburn, but the explanation of this observation was uncertain because the proportion of patients using regular antacids was similar in the two groups. Other studies have found no difference between laparoscopic and standard cholecystectomy, in the subsequent incidence of heartburn, although the regular antacid usage rate was higher in some LC groups [11,16]. In the current study, no significant difference was observed in postoperative gastrointestinal symptoms between the two groups.…”

“…Although 97% of the patients were satisfied with the results of their surgery, 9% still reported upper abdominal trouble and slight persistent problems such as light pain or flatulence. Other studies have reported superior clinical results when comparing the symptomatic outcome of patients who had LC with that of historical open surgery control subjects [8,11,13,16]. Stiff et al [11] reported that reports of right upper quadrant pain were significantly fewer after LC than after conventional surgery, suggesting that the reason might be the damaged intercostal nerves.…”

Mini-laparoscopic versus Traditional Laparoscopic Cholecystectomy: preliminary study

“…[4,16,17] If minimal invasiveness is the reason of these benefits compared to open cholecystectomy, then it could be hypothesized that further miniaturized instruments would cause less tissue trauma and further improved outcomes.…”

Persistence of Symptoms After Laparoscopic Cholecystectomy

“…However, in 20% -30% of patients significant pain and dyspeptic symptoms still persist (8)(9)(10)(11)(12)(13)(14)(15)(16). Laparoscopic cholecystectomy (LC) offers marked and definite advantages with regards to early ambulation, decreased duration of hospital stay, less postoperative pain, improved postoperative pulmonary function, decreased or equivocal post-op complication rates and decreased time to return to normal day to day activities as has been demonstrated in both randomized controlled trials (17)(18)(19) and cohort studies (20)(21)(22).…”