Laparoscopic Cholecystectomy for Gallbladder Dysfunction and Polyps: Incidence and Follow up

Area of Science:

• Gastroenterology
• Surgical Gastroenterology
• Hepatobiliary Surgery

Background:

• Cholecystectomy is commonly performed for gallstones.
• Acalculous gallbladder disease, including functional gallbladder disorder (FGBD) and gallbladder polyps (GBP), presents diagnostic challenges.
• Evaluating the outcomes of cholecystectomy in patients without gallstones is crucial for refining treatment strategies.

Purpose of the Study:

• To determine the incidence, indications, and outcomes of cholecystectomy in patients with acalculous gallbladder pathology.
• To assess the long-term efficacy of laparoscopic cholecystectomy (LC) for FGBD and GBP.

Main Methods:

• Analysis of prospectively collected data from 5675 patients undergoing LC over 28 years.
• Inclusion of patients with biliary symptoms but no gallstones on ultrasound, abnormal hepatobiliary iminodiacetic acid scans, or confirmed gallbladder polyps.
• Comparison of patient demographics, surgical findings, and outcomes between acalculous cases and those with gallstones.

Main Results:

• Acalculous pathology (FGBD and GBP) accounted for 2% of LCs.
• Patients with FGBD/GBP were younger and had fewer prior biliary admissions than gallstone patients.
• LC was technically easier, with shorter operation times and fewer drains, and provided good symptomatic relief in over 95% of FGBD and GBP cases.

Conclusions:

• Functional gallbladder disorder and gallbladder polyps are infrequent indications for cholecystectomy.
• Laparoscopic cholecystectomy is a safe and effective treatment for selected patients with FGBD and GBP, offering significant long-term symptom resolution.
• FGBD should be considered in the differential diagnosis of right upper quadrant pain in the absence of gallstones.