Cholecystectomy for biliary dyskinesia: how did we get there?

Area of Science:

• Gastroenterology
• Hepatobiliary Surgery
• Functional Gastrointestinal Disorders

Background:

• The understanding of biliary dyskinesia (BD) has evolved from post-cholecystectomy symptoms to include gallbladder dysfunction with normal morphology but low ejection fraction.
• Impaired gallbladder contraction affects a significant portion of the population, including healthy individuals and those with other medical conditions.

Purpose of the Study:

• To systematically review the diagnosis and treatment of gallbladder dysfunction.
• To evaluate the role of functional gallbladder testing in identifying patients who may benefit from surgical intervention.

Main Methods:

• Systematic review of studies from the PubMed database.
• Focus on diagnosis and treatment of gallbladder dysfunction.

Main Results:

• Surgery for BD has increased, particularly after the advent of laparoscopic cholecystectomy (CCY), now representing a substantial proportion of CCY procedures in adults and children.
• Postoperative outcomes are comparable between patients with normal and abnormal gallbladder function.
• The prevalence of impaired gallbladder contraction is notable in both healthy controls and patients with various disorders.

Conclusions:

• Functional gallbladder testing should not be used to predict relevant biliary tract disease or identify surgical candidates.
• Biliary dyskinesia is best viewed as a functional disorder managed conservatively.
• Emerging evidence suggests medical therapies may be effective for biliary dysfunction, warranting further investigation in rigorous trials.