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Chronic acalculous cholecystitis: laparoscopic treatment
D B Jones1, N J Soper, J D Brewer
1Institute for Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Surgical Laparoscopy & Endoscopy
|April 1, 1996
Summary
Laparoscopic cholecystectomy effectively treats biliary colic in patients with biliary dyskinesia. However, persistent gastrointestinal issues are common post-surgery, even with successful pain relief.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
- Diagnostic Imaging
Background:
- Recurrent biliary colic without gallstones presents a diagnostic challenge.
- Biliary dyskinesia, characterized by abnormal gallbladder function, is often suspected in these cases.
Purpose of the Study:
- To evaluate the efficacy of laparoscopic cholecystectomy in patients with biliary colic and no ultrasonic evidence of gallstones.
- To assess the histological findings of the gallbladder and the long-term outcomes after surgery.
Main Methods:
- 36 patients with biliary colic and no gallstones underwent laparoscopic cholecystectomy.
- Preoperative evaluations included ultrasound, hepatobiliary scans (measuring gallbladder ejection fraction - EF), and cholecystokinin provocation tests.
- Gallbladder histology was examined post-surgery.
Main Results:
- Hepatobiliary scans revealed a low EF (<35%) in 88% of patients.
- Laparoscopic cholecystectomy relieved biliary colic in 93% of patients with low EF and 75% with normal EF.
- Histological examination showed chronic inflammation in 83% of gallbladders, though retrospective review identified significant inflammation in only 38%.
Conclusions:
- Laparoscopic cholecystectomy is effective for biliary colic in patients with biliary dyskinesia and low gallbladder EF.
- While biliary colic is resolved, persistent non-biliary gastrointestinal complaints are frequent post-operatively.