Gallbladder motility in laparoscopic cholecystectomy specimens

In vitro contractility of human and sheep gallbladders to cholinergic stimulation with carbachol and the effects of indomethacin on abnormal rhythmic activity were studied. Once hundred and thirty-two gallbladders were obtained at laparoscopic cholecystectomy, 38 from patients with acute and 94 with chronic cholecystitis. In addition, 27 specimens of sheep gallbladders served as controls. Fundal preparations from patients with cholecystitis exhibit hypocontractility: no response in 72% or in the remainder a significantly reduced maximal contraction to carbachol. Regionally graded motor responses favoring propulsion of bile were abnormal in 44% of the gallbladders studied with more forceful contractions of the duct compared to the fundus. Abnormal early rhythmic activity (ERA) of fundal preparations was only detected in gallbladders of patients (in 33%) but never in controls. In 80% of these, ERA was blocked or reduced by indomethacin which can be interpreted as evidence for a prostaglandin-mediated inflammatory response. We conclude that gallbladder motility in cholelithiasis secondary to muscarinic stimulation is reduced and regionally graded motor responses favoring bile expulsion are impaired. ERA can be blocked by indomethacin.