Factors influencing the long term results of cholecystectomy

800 patients who underwent cholecystectomy have been reviewed and evaluated in an attempt to establish the frequency and severity of postcholecystectomy symptoms and to analyze the possible factors influencing these distresses. There were 551 patients who had symptomatic cure; 217, mild symptoms; and 32, severe symptoms. Residual stones in the common bile duct and stenosis at the sphincter of Oddi were found to be the underlying causes of severe postcholecystectomy distress. Helpful in detecting common bile duct diseases was telecholangioscopy associated with cholangiography, the routine use of which decreased from 8 to 2% the percentage of overlooked biliary disorders. The procedure of choice in the treatment of residual stones in the common bile duct and stenosis at the sphincter of Oddi was sphincteroplasty, which provided excellent long term results with a low operative mortality rate. Mild postcholecystectomy symptoms were found to be related to hepatic damage which usually is present in patients with gallbladder diseases. Accordingly, the frequency of these distresses was significantly influenced by the degree of hepatic damage present before operation. Patients with a long interval between onset of symptoms and cholecystectomy and with severe inflammation of the gallbladder had a higher incidence of mild distress. These findings are a strong argument for early cholecystectomy.