Impact of elective laparoscopic cholecystectomy on symptom improvement: a cross-sectional study

Background: Laparoscopic cholecystectomy (LC) is widely accepted as the treatment of choice for symptomatic gallbladder disease and usually leads to favorable postoperative results. Nevertheless, some patients continue to report persistent or recurrent symptoms despite surgery. This study aimed to determine whether pre-operative complaint duration, symptom severity, and endoscopic retrograde cholangiopancreatography (ERCP) are associated with symptom persistence following LC. Methods: This cross-sectional study was carried out at Dr. Soliman Fakeeh Hospital in Jeddah, Saudi Arabia, and included patients who underwent LC between January 2019 and December 2021. We collected information on demographics, pre-operative symptom duration and severity, perioperative interventions, such as ERCP, and post-operative symptoms and patient satisfaction. The patients were grouped into those whose symptoms improved after surgery [designated as having symptoms alleviated (SA)] and those with persistent symptoms [classified as having symptoms persist (SP)]. Statistical analyses included Chi-squared tests, Mann-Whitney U tests, and Spearman’s rank correlation to identify the factors associated with ongoing post-operative symptoms. Results: Overall, 220 patients answered the survey. The patients were followed for 30.7±7.8 months after surgery. Approximately one-fifth of patients (40/220, 18.2%) experienced persistent abdominal pain after cholecystectomy. The patients’ age, sex, comorbidities, body mass index (BMI), diagnosis, symptoms intensity, emergency room visit, surgery setting, approaches, and ERCP did not show statistically significant differences between the SA and SP groups. The duration of complaints before surgery was significantly shorter in the SA group vs. the SP group (23.7±18 vs. 45.9±31 weeks, P=0.050), respectively. After surgery, 18.2% (40/220) had abdominal pain, 1.8% (4/220) had wound infection, 21.8% (48/220) had persistence scar pain, 4.5% (10/220) had biliary stones, 26.8% (59/220) had heartburn, 30.4% (67/220) had diarrhoea, and 5% (11/220) had incisional hernia. A longer symptom duration showed a borderline association with post-operative symptom persistence [rho=−0.132; P=0.050; 95% confidence interval (CI): −0.26 to 0.00], while the post-operative complications were significantly correlated with symptom persistence (rho=−0.198; P=0.003; 95% CI: −0.32 to 0.06). Only 8.6% (19/220) of patients were unhappy with the result of their surgery. Conclusions: One-fifth of patients may continue to report unchanged symptoms following LC, even though diagnostic tools have improved. Factors such as the duration of the complaint and post-operative complications may be associated with symptom persistence following surgery. Pre-operative procedures such as ERCP have no effect on symptom persistence post-cholecystectomy. Better outcomes cannot be achieved without patient counselling and careful selection.