The surgical gallbladder

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical Pathology

Background:

• Analysis of 412 cholecystectomies performed by the surgeon.
• Categorization of surgical cases based on preoperative gallbladder visualization via cholecystography.
• Inclusion of a group requiring immediate surgery without prior radiological assessment.

Observation:

• Exclusion of cases diagnosed with dyskinesia based solely on radiological findings.
• Identification of diverse, less common pathological lesions in patients operated on for presumed chronic cholecystitis.
• Discussion of bilharzial gallbladder disease, proposing new terminology: bilharzial cholecystitis and bilharzioma of the gallbladder.

Findings:

• Histological examination revealed varied pathologies beyond chronic cholecystitis.
• The study highlights the importance of common bile duct exploration, inspection, and aspiration.
• Complete elimination of biliary fistulas in the series through meticulous common bile duct management.

Implications:

• Revises diagnostic criteria for cholecystitis, emphasizing histological confirmation over radiological signs like dyskinesia.
• Suggests novel terminology for bilharzial gallbladder disease, aiding in its recognition and study.
• Advocates for common bile duct exploration as a safe and effective alternative to operative cholangiography, improving surgical outcomes and reducing complications like biliary fistulas.