Role Of Cholecystectomy Research Articles

Management of patients with ultrasound negative biliary colic: The role of cholecystectomy

Background: Management of pts with biliary colic sxs (right upper quadrant abdominal pain with or without nausea)and negative ultrasound exam for gallstones can be challenging. The aim of this study was to ascertain the role of cholecystectomy in these pts. Methods: We restrospectively reviewed records of 229 pts who were evaluated at our institution between 1994 and 1999. Of 229 pts, 179 pts (78%) underwent cholecystectomy and 50 pts (22%) were managed without surgery. The two groups of pts were similar in terms of age, gender, sx duration and other clinical characteristics. All pts were evaluated by a gastroenterologist and had tests including ultrasound of the abdomen, cholecystokinin stimulated cholescintigraphy (CCK-CS), upper orX-ray or endoscopy. Pts (I 85F, 44M, avg age 45 yrs) were followed up for an avg of 26.7 mos (range 4-70 mos). Data including gallbladder motility, reproduction of biliary colic sxs during CCK-CS and gallbladder histology were abstracted. Results: Of 179 pts who were treated with cholecystectomy, 154 (86%) had resolution of biliary colic. Of 50 pts who were managed without cholecystectomy, 16 (32%) had symptom improvement (P<.OI). Of 179 pts who underwent surgery, 130 (73%) had histologic evidence of cholecystitis and 49 (27%) did not. Histologyproven cholecystitis was not a good predictor of sx resolution after surgery (114/130 vs 40/49)(P=NS). Of the 179 pts who had surgery, 122 (68%) had abnormal pre-operative gallbladder motility and 57 (32%) had normal motility. Of 50 pts who did not have surgery, 21 (42%) had abnormal motility and 29 (58%) had normal motility. Pts with abnormal gallbladder motility had a similar symptomatic outcome as pts with normal motility with or without cholecystectomy (P=NS). Of 179 pts who had surgery, 155 (87%) had biliary colic sxs reproduced following CCK challenge during CCK-CS and 24 (13%) did not. Of 50 pts who did not have surgery, 39 (78%) had biliary colic sxs reproduced following CCK challenge and II (22%) did not. Among pts who had CCK-induced sx reproduction, 137 (88%) improved following surgery, 28 (72%) failed to improve symptomatically without surgery (P<.OI). Conclusion: Cholecystectomy is effective in relieving sxs in pts with ultrasound negative biliary colic. CCK induced sx reproduction appears to be a good prognostic indicator of the clinial outcome.

Double barrelled common bile duct: A threat to biliary surgery

The frequency of cholecystectomies has given the surgeon familiarity and confidence when dealing with biliary anomalies. Internal anomalies are not equally recognized, for they play little role in cholecystectomy. Recognition of internal anomalies is of prime importance, however, when the biliary tree is drained through the gallbladder. Radiographic confirmation of a patent drainage system, avoiding spillage of contrast material, should be routinely employed in these situations to obviate potentially lethal complications due to technical error.