Can a surgeon perform a macroscopic inspection of a gallbladder?

Abstract

Introduction: Routine histopathologic gallbladder examination after cholecystectomy has been a point of discussion for several decades. Recent changes in national guidelines suggest a selective histopathologic examination gallbladders. The aim of this study was to evaluate the macroscopic examination by the surgeon in relation to the final histology outcome. Method: A prospective study was conducted in a Dutch teaching hospital to investigate the practice of macroscopic gallbladder examination by a surgeon compared to routine histopathology by a pathologist. All consecutive cholecystectomies were included between November 2009 and February 2011. Patient characteristics, operative procedure, conversions to laparotomy, macroscopic examination of the gallbladder mucosa, alleged necessity for microscopic analysis and final histopathology of the gallbladder were analyzed. Results: A total of 319 consecutive cholecystectomies were performed. Twenty-nine patients were treated for acute cholecystitis. Of all macroscopic examinations the surgeon identified 62 gallbladders with macroscopic abnormalities, ranging from polyps to wallthickening or ulcers. Including acute cholecystitis a total of 55 (17,2%) could have had reasons for further microscopic evaluation by the pathologist. Macroscopic examination agreement between surgeon and the pathologist was rated as “strong agreement” (κ = 0,822). The surgeon and the pathologist had disagreement on the macroscopic examination of 18 gallbladders. In these gallbladders, however, the additional histology was not relevant to clinical outcome. Conclusions: The present prospective study shows that the surgeon is capable of adequate macroscopic gallbladder examination postoperatively. We suggest to only perform selective microscopic gallbladder examination, which can result in about 80% reduction of this kind of routine histology.