Twenty to thirty year follow-up after cholecystectomy

We studied retrospectively the need for re-examinations and re-operations, the development of alimentary tract cancer, and the occurrence of abdominal symptoms 20-30 years after elective cholecystectomy.

Between 1963 and 1973 296 patients (73 males and 223 females) were treated by cholecystectomy. The indication was biliary colics plus stones in gallbladder. Patients with biliary-enterostomy, sphincteroplasty or synchronous extrabiliary operations were excluded. Retained bile duct stones were excluded by cholangiography. Medical records of all patients, death certificates of the patients who had died during the follow-up (n = 74), and the autopsy findings of autopsied patients (n = 29) were reviewed. The living 220 patients were interviewed by a structured questionnaire a median of 26 years after the operation.

Patients were divided into two groups: Group I (172 patients) underwent cholecystectomy only and Group II (122 patients) underwent cholecystectomy and common duct stone extraction. During the follow-up, 25 patients (9%) underwent examinations for biliary colics and 12 (4%) were re-operated, 10 during 1-5 years after cholecystectomy. Both the examinations and re-operations were more common in Group II than in Group I (p < 0.005). Eight patients developed alimentary tract cancer during the follow-up. Thirty-nine per cent of patients reported abdominal symptoms, 20% having had these already prior to cholecystectomy. Abdominal pain was reported by 21%, distention by 20%, heart burn 16%, obstipation 14%, and diarrhea by 11%. Abdominal pain and diarrhea occurred more frequently in Group I than in Group II.

Recurrent biliary colics and stones in the common bile duct are extremely rare later than five years after cholecystectomy and are not expected unless the patients have also initially had common duct stones. One third of patients suffer from other abdominal symptoms.