Long-term Outcome After Open Versus Laparoscopic Cholecystectomy In The Prevalence Of Postcholecystectomy Syndrome

Objective: Cholecystectomy is an common procedure to treat gall- bladder diseases with effective and satisfactory clinical results.But still, within few months or even after several years, about 25 percent to 30 percent of postoperative patients continue to suffer from symptoms such as right upper abdominal pain, bloating,digestion dysfuction,bile duct obstru- cttion and inflammation,all of which are defined as postcholecystectomy syndrome(PCS).Due to the high morbidity of the gallbladder stone diseases and the prevalence of the cholecystectomy, and laparoscopic cholecy- stectomy(LC) for that matter,the amount of the PCS patients are advancing. LC,comparing with open cholecystectomy(OC),are in possession of many advantages such as minimal invasion, less pain,fewer disturbance to the inner guts,so as to reduce the morbidity of the PCS.However,there are still deficiencies in LC,as the leaking diagnosis for the co-existed diseases, doctor's 3-D operative view turning to 2-D, perspective deviation, touch- ment clumsy and no chance of common bile duct exploration,so exits the remnant calculus and recurrence the symptoms.That is why the introduction of laparoscopic techniques have less improvement with the PCS. However,OC is inevitably replaced by LC due to the prosperous prospect of the minimal invasive techniques and positive long-term outcome. Our study is to report the long-term outcome comparison of the prevalence of PCS with OC and LC.To prove the clinical effects and safety of LC with no negative impact on PCS.Method: Between september 2007 and september 2008,the chole- cystectomy were performed in more than 460 patients with benign gall- bladder diseases at general surgery department of First Affiliated Hospital of Dalian Medical University.Among them,we randomly selected 114 patients,which were divided into OC group and LC group.The OC group consisted of 39 patients, without common duct exploration or other additional procedures were.The LC group consisted of 75 patients, conver- sion to OC were excluded.Patients in both groups were interviewed preo- peratively about general data and their history,asked to give a detailed description of their smyptoms and performed a diagnostic techniques.The follow-up of both groups was identical:after a minimun of 10 months the patients were interviewed about the exact description of their symp- toms.The pain and symptoms were classfied into four grades,which was caculated to assess the differences between the two groups.Results: the operations were performed successfully in all the 114 patients.There was no significant difference between the two groups with sexual,age ,preoperative symptoms,history and follow-up time.After a mean follow up of 13 months for open group and 14 months for laparoscopic group,no patients was dead.Through evaluation,there was no significant differences in the long-term outcome of the prevalence of postcho- lecy- stectomy syndrome.However,the scar-related inflammation and nonin- flammation in the open group are much more common than in the laparo- scopic group.Conclusions: Concerning the prevalence of PCS,there was no significant differences in the long-term outcome after OC and LC.In spite of the losing touchment to the inner guts and leaking diagnosis for the co-existed diseases and also the remnant of the common bile duct stones, LC did not raised up the prevalence of PCS.