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Introduction: Up to 20% of patients undergoing cholecystectomy continue to experience symptoms. We consider such results unacceptably high and in need of further evaluation.

Objectives: To identify the biliary symptoms for which the cholecystectomy was carried out and then determine the prevalence and the nature of persistent symptoms following cholecystectomy in a cohort of 500 consecutive cases.

Methods: A validated pre-operative symptoms survey was completed at the time of listing of 500 consecutive laparoscopic cholecystectomies (LC) followed by a follow up phone survey 12 weeks after the procedure to record the nature, severity and frequency of symptoms experienced pre- and post-operatively. A detailed clinical profiling was carried out on all patients with persistent biliary symptoms.

Results: All patients had at least 2 symptoms pre-operatively and 337 (67.4%) had 3 or more. The most common symptoms pre-operatively were abdominal pain (93.8%), nausea (65.8%), pain related to food (54.4%) and bloating (48.6%).

A total of 90 patients were symptomatic post-operatively. Eighty one patients (16.2%) complained of abdominal pain, while 63 (12.6%) patients also experienced associated dyspeptic symptoms. Seventy three patients (14.6%) developed 1 or more new symptoms post-operatively, the most common being heartburn found in 34 (6.8%) and abdominal bloating in 29 (5.8%).

Sixty patients underwent further investigation following LC; 36 patients went on to have a secondary diagnosis made, the most common (13/36) being hiatus hernia, seven patients were found to have a retained common bile duct stone. Overall, there was no significant difference in histology among patients post-operatively.

Conclusion: A significant number of patients continue to experience symptoms following laparoscopic cholecystectomy. In patients were pain was the most troublesome symptom pre-operatively, significant symptomatic improvement was noted. Similarly, those patients that experienced symptoms more dyspeptic in nature pre-operatively were less likely to be symptom free following LC. A careful biliary history, a focused physical examination and a thorough pre-operative assessment must be carried out prior to LC to rule out conditions that masquerade as gallbladder disease.