Laparoscopic Cholecystectomy for Acalculous Gallbladder Disease (Clinical Report)
Use of laparoscopic cholecystectomy (LC) to treat patients with symptoms due to gallstone disease is well established. However, use of LC for patients with acalculous gallbladder disease remains controversial. In this study, we examined the use of hepatobiliary iminodiacetic acid (HIDA) scans with cholecystokinin (CCK) infusion to identify patients with acalculous gallbladder disease who would benefit from LC. From December 1991 to February 1997, 4480 patients underwent cholecystectomy at Baylor University Medical Center, including 72 patients who underwent LC for acalculous disease following preoperative HIDA scan. We retrospectively analyzed their preoperative symptoms and workup. Follow-up was obtained by telephone questionnaire in 59 of 72 patients (82%). Overall, 48 of 59 patients (82%) reported an excellent outcome following LC. We found no significant difference in outcome in patients who underwent HIDA scan with CCK infusion, regardless of gallbladder ejection fraction or exacerbation of symptoms caused by the infusion. Preoperative symptom complex was also not predictive of postoperative outcome. LC is an effective treatment for patients with acalculous gallbladder disease. A preoperative HIDA scan with CCK infusion does not accurately predict treatment success or failure. Patients with a normal ejection fraction and absence of symptoms from a HIDA scan can still have excellent relief of symptoms after LC. Since its introduction in 1989, laparoscopic cholecystectomy (LC) has emerged as the treatment of choice for patients with symptomatic cholelithiasis, acute cholecystitis, and biliary pancreatitis (1). Preoperative workup of these patients is well established, and long-term relief of symptoms has been reported to approach 95% (2). However, preoperative workup and treatment for patients who present with symptoms of gallbladder disease but do not have gallstones remain unclear. Symptoms are usually consistent with biliary colic, such as right upper quadrant pain, epigastric pain, or postprandial nausea and vomiting. An exhaustive diagnostic workup with sonography, computed tomography scan, esophagogastroduodenoscopy, colonoscopy, endoscopic retrograde cholangiopancreatography, and upper gastrointestinal series may not provide an acceptable explanation for the patient’s symptoms. Often there are long delays between initial presentation and final treatment.