# 2219 The Therapeutic Efficacy of Laparascopic Choleycystectomy in the
Treatment of Biliary Dyskinesia.
Nilesh A. Patel, Jason J. Lamb, Daniel J. Gagne, Dennis L. Fowler,
Pittsburgh, PA
Nearly 700,000 laparoscopic cholecystectomies (LC) are performed each
year. This number has grown in recent years, with the vast majority of
procedures performed for either acute cholecystitis or symptomatic
cholelithiasis. While the diagnostic algorithm, indications, and benefit of
LC have been well documented in these situations, there remains a group
of patients who present with classic biliary colic without evidence of
cholelithiasis or acute inflammation. With the innovation of CCK-HIDA
scan, an effective gallbladder functional study exists. However, currently,
there are few studies that have looked at the predictive value of a positive
CCK HIDA scan. In the present study, 1120 consecutive LC were reviewed
over a 33 month period. Biliary dyskinesia, or a gallbladder ejection fraction
(GBEF) of less than 50%, was found in 204 preoperative patients. Of
these patients, 148 were available for follow-up (mean of 16 months) and
they were divided into two groups. Group I (n = 121) were patients with a
GBEF of <50% without evidence of cholelithiasis or biliary sludge. Group
II (n = 27) included patients with a GBEF of < 50% in addition to documented
cholelithiasis or biliary sludge. Ninety four percent of patients in
Group I reported either complete or significant relief in their preoperative
symptoms while 6% reported no relief. Of the 94%, 66% had complete
relief. There was no significant correlation between the degree of relief and
measured ejection fraction. Males in Group I were less likely to have complete
resolution of their symptoms as compared to women in that group.
No significant difference was noted in the degree of relief between Group I
and Group II. Based on these findings, we feel that the CCK-HIDA scan in
conjunction with clinical presentation is an acceptable means of identifying
patients with biliary dyskinesia who will benefit from a LC.
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