Aims: The incidence of bile duct injuries (BDI) and symptomatic residual bile duct stones in patients undergoing elective laparoscopic cholecystectomy (LC) without routine use of intraoperative cholangiography (IOC) were studied. The appropriateness and long-term results of elective LC in the treatment of gallstone disease in the elderly patients were analyzed. The rate of abdominal symptom persistence after elective LC along with its dependence from preoperative symptom severity in uncomplicated gallstone patients was clarified. In addition, the feasibility and applicability of single incision laparoscopic cholecystectomy (SILC) in small-volume community hospitals were assessed. 

Patients and methods: Patient records of all 1,101 patients (mean age 53 years, range 15 - 89 years, 874 females and 227 males) who had elective LC for gallstone disease in Turku City Hospital for Surgery between 1992 - 2001 were retrospectively studied. Data concerning long-term outcomes were obtained with questionnaire sent to the available patients in 2004. Short- and long-term results of elderly patients (age ≥ 75 years, n = 80) were compared with the two younger age groups (< 65 years and 65 - 74 years, n = 80 in each). Recurrence rates of abdominal symptoms in patients who have had uncomplicated gallstone disease with severe (n = 380) and mild (n = 287) preoperative symptoms, were compared. The details and outcome of SILC in 51 consecutive patients were recorded and analyzed. 

Results: The incidence of BDIs was 0.5% (n = 5) and symptomatic residual bile duct stones 0.9% (n = 10). The mean hospitalization time and the rate of complications increased with the age of the patients. Eighty percent of patients aged ≥ 75 years were satisfied or very satisfied with the long-term results of the procedure. Thirty-seven percent of patients continued to have abdominal symptoms postoperatively (41% of patients with mild preoperative symptoms and 33% with severe symptoms, p = 0.052). Eighty-two percent of SILCs succeeded without conversion to multi-port or open surgery. No major intra- or postoperative complications occurred in SILC patients, but 10% of patients had postoperative wound infection. 

Conclusions: Both the incidence of BDIs and symptomatic postoperative bile duct stones remain low without the routine use of IOC. Also in elderly, elective LC seems safe and feasible operation with good long-term results. More than one third of the patients with uncomplicated gallstone disease experienced persistent symptoms after elective LC. Patients with mild preoperative symptoms may have more recurrences. SILC can be adopted without major complications in small-volume hospitals but the rate of wound infections seems to increase with the introduction of SILC.