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Introduction: The results in almost all studies on biliary dyskinesia are based on short term surgical follow up. They do not take into consideration that most patients are discharged from surgical follow up after the first postoperative visit if their symptoms are better and for persistent or recurrent symptoms they are frequently seen by Primary Care Providers and subsequently referred to Gastroenterologists (GI). We did an extensive Pubmed search using the words “biliary dyskinesia” and could not find any study which took this into consideration. We attempted to study this pattern and assess which factors if any predict patients that will benefit from cholecystectomy. We benefit from an extremely homogenous patient population our hospital being the only tertiary care hospital serving a rural population for a considerable distance.Method: Retrospective analysis of medical records of patients who underwent cholecystectomy for biliary dyskinesia from February 2001 to January 2010 with minimum postoperative follow-up of 6 months. Results and discussion: After an initial analysis of 274 patients only 141 patients were included in the study based upon our inclusion and exclusion criteria. Of the 141 patients 117 (83%) were female and 24 (17%) male. Symptoms for which patient underwent cholecystectomy were persistent or recurred in 61 of 141 (43.3%) patients postoperatively. Although most patients on initial surgical follow-up said symptoms had improved however 58/141 patients were seen by the GI service with persistent symptoms over a time range of 1- 63 months (median at 5 months, mean 9 months). An upper GI endoscopy was performed in 40 of 141 (28.4%) patients for persistent symptoms. The mean ejection fraction (EF) on radionuclide imaging in patients with persistent symptoms was 18.0% (95% CI range 13.8- 22.2) compared to almost similar mean EF 18.04% (95% CI range 15.0- 21.0) in patients who had resolution of symptoms. In the group of patients who had reproduction of symptoms with cholecystokinin, 49 of 82 (59.8%) had resolution of symptoms.Review of surgical pathology revealed that only 54 of 141 (38.3%) specimens were normal while 75 of 141 showed mild chronic inflammation. The only factor that was significantly different between the two groups of patients with and without resolution of symptoms after cholecystectomy was whether the pathology was normal versus if there was inflammation, chi square p value=0.02Conclusion: Although our study has the limitation of being a retrospective analytical study it raises it some important issues. Cholecystectomy does not appear to be as effective for biliary dyskinesia as most studies suggest when long term follow up including that with Gastroenterology is accounted for. If operative pathology shows chronic inflammation the patients are significantly more likely to have resolution of symptoms.
Operative pathology

Normal	54	38.3%
Mild chronic inflammation	70	49.6%
Cholesterolosis	12	8.5%
Cholesterolosis and inflammation	5	3.5%
Total	141	100%