Persistence of Symptoms Following Laparoscopic Cholecystectomy for Symptomatic Cholelithiasis: A Prospective Observational Study

Introduction: Laparoscopic cholecystectomy is the standard surgical treatment for symptomatic cholelithiasis, but a proportion of patients continue to experience abdominal or gastrointestinal symptoms after surgery.This study evaluated the frequency of persistent symptoms and the resolution pattern of individual gastrointestinal symptoms following laparoscopic cholecystectomy.Methods: This prospective longitudinal observational study was conducted at Pushpagiri Institute of Medical Sciences and Research Centre, Thiruvalla, Kerala.Eligible patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis were prospectively enrolled and followed for one to six months after surgery through outpatient visits or telephone follow-up.Symptoms were recorded using a predefined structured proforma; no separate validated gastrointestinal symptom score was used.Of 70 enrolled patients, four who underwent open cholecystectomy were excluded, and eight were lost to follow-up, leaving 58 patients for final analysis.Paired preoperative and postoperative symptom status was compared using the exact McNemar test.Results: Among the 58 patients who completed follow-up, 39 were female, and 19 were male.Persistent postoperative symptoms were observed in eight patients (13.8%), while 50 patients (86.2%) were symptomfree.Among patients with persistent symptoms, upper abdominal pain was present in all eight (100%), bloating in five (62.5%), and constipation in six (75%).Symptom resolution varied according to the presenting complaint.The resolution rates were 87.2% for nausea, 88.9% for vomiting, 88.2% for heartburn, 81.8% for early satiety, 92.6% for food intolerance, and 80.0% for bloating.Constipation showed comparatively poor resolution (44.4%).Conclusion: Most patients experienced substantial symptomatic improvement after laparoscopic cholecystectomy, but approximately one in seven had persistence of at least one preoperative symptom during one-to six-month follow-up.Nonspecific gastrointestinal complaints, particularly bloating and constipation, may resolve less consistently.Preoperative counselling should distinguish typical biliary symptoms from potentially non-biliary symptoms and explain that complete symptom resolution cannot be guaranteed.