2000 Abstract: 2219: The Therapeutic Efficacy of Laparascopic Choleycystectomy in theTreatment of Biliary Dyskinesia.
Abstracts
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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. |
