To analyze patients with chronic acalculous cholecystitis over ten years, during which laparotomy was replaced by laparoscopy as the dominant operation for cholecystectomy in regard to patient demographics, diagnostic evaluations, follow-up symptoms, and additional operations. Of cholecystectomies from June to June , patients had chronic acalculous cholecystitis.
All subsequent hospital admissions and emergency room visits were reviewed through May Office records were available for review in cases. Two eras were defined, the open era from June through May , and the laparoscopic era from June through June Twice as many patients with chronic acalculous disease underwent cholecystectomy after the advent of laparoscopy.
Patients with chronic acalculous disease were significantly younger than patients with cholelithiasis in both open and laparoscopic cases. The percentage of white women increased from The numbers of preoperative diagnostic tests performed decreased from 4.
Twenty-two percent of patients had continued symptoms postoperatively, and 8 patients 2.
Chronic acalculous cholecystitis is a disease of white females, doubling in frequency over the decade of review. Previous reports indicate that the number of patients undergoing cholecystectomy has increased since the introduction of laparoscopic cholecystectomy LC. The purpose of this study was to evaluate a relatively geographically isolated population of patients undergoing elective cholecystectomy without cholelithiasis over the period of time in which open cholecystectomy OC was supplanted by the laparoscopic approach with respect to changing preoperative evaluation, time of original symptom development to operation, and postoperative course and symptomatology.
Some comparisons to patients with calculous biliary disease also are identified and discussed.
This retrospective study consisted of all patients who underwent cholecystectomy for chronic acalculous cholecystitis in Saginaw, Michigan between June 1, and June 30, The latter date was selected to allow for at least 18 months of postoperative follow-up. The first LC was performed on June 14, Patients were identified by reviewing all charts assigned ICD-9 codes for cholecystectomy X codes for disease not associated with cholelithiasis defined as Of patients with acalculous cholecystitis, were excluded due to acute acalculous disease.
Of the remaining patients from June through May and from June through June , patients were excluded in the LC era and 95 from the OC era due to 1 calculus disease identified preoperatively and not confirmed intraoperatively or at pathologic review, and 2 acalculous disease preoperatively found to have calculi at operation or on pathologic analysis. The remaining patients were reviewed for presenting symptomatology, patient characteristics, preoperative diagnostics, as well as postoperative symptomatology, evaluation, diagnoses, and operations performed after cholecystectomy.
Office records were available for review for cases, 25 from the OC era and from the LC era. Statistical analysis was performed using the SPSS statistical program utilizing Fischer's exact test, Chi-square, and paired t-test as appropriate.
During the decade from June to June , cholecystectomies were performed. Of this total, patients had cholelithiasis; the remainder had diagnoses of acute or chronic acalculous cholecystitis or biliary dyskinesia.
Cholecystitis cronica calculosa pdf to jpg
During the study period, of 4. All patients presented with abdominal pain; other symptoms included episodic vomiting, bloating, frequent eructation, fatty food intolerance, diarrhea, and dyspepsia.
The mean age of patients with acalculous disease was In both eras, the mean age was significantly younger than those with stones The vast majority of all patients undergoing cholecystectomy for all diagnoses were white women, Similarly, there was a statistically significant increase in the percentage of white women with chronic acalculous disease from Patients in the LC and OC eras did not differ in preoperative body mass index, number of medications, or number of positive laboratory tests.
There were no other significant differences in the other 13 medications studied between the groups of patients.
The number of tests performed significantly decreased from 4. Positive US findings occurred in Twenty-two 7.
Of these, 8 patients 2. No statistically significant difference existed between OC and LC groups in the incidence of subsequent operations performed within one year of cholecystectomy.
In this series of patients from a relatively isolated geographic community, the prevalence of cholecystectomy for chronic acalculous cholecystitis almost doubled during the decade studied—an increase sustained and statistically significant since the introduction of laparoscopy. Patients who underwent LC for chronic acalculous disease had on average three preoperative tests prior to cholecystectomy as compared to nearly five per patient in the OC era.
In the vast majority of the laparoscopy cases, these tests included an ultrasound for gallbladder structure and the CCK-HIDA for gallbladder function. Only one additional test was performed not specific for biliary pathology prior to operation. The decreasing numbers of tests performed since the introduction of laparoscopy may, therefore, be due to the increased use of the CCKHIDA scan.
The CCK-HIDA was the first specific test for chronic acalculous disease, and its increase coupled with decreased utilization of other preoperative evaluations may indicate increasing physician awareness of the disease and the appropriateness of the CCK-HIDA as a predictor of postoperative success after cholecystectomy.
Patient demographics indicate that this is an operation of white females, more so since the advent of laparoscopy. Although many believe there is a preponderance of females with biliary disease, an etiologic factor has not been identified that explains this overwhelming majority of patients with acalculous disease.
The concurrent racial demographics during this study are not precisely known; however, there was a statistically significant increase in the number of white females with chronic acalculous cholecystitis compared with patients with cholelithiasis. This may reflect an unknown bias in this review and may deal with access to health care, insurance status, or referral patterns from more outlying rural areas more likely to consist of Caucasians. Other investigators demonstrated no relation between decreased gallbladder ejection fraction and the findings of chronic cholecystitis on pathology.
Patients with irritable bowel syndrome may also have reproduction of pain with CCK stimulation. Half of these patients developed reproduction of symptoms with the CCK.
The change from open to laparoscopic cholecystectomy was accompanied by more white females undergoing operation for acalculous biliary disease. The number of preoperative diagnostic evaluations has decreased since the advent of laparoscopy. The true incidence of persistent symptoms may be underestimated in this study because of incomplete long-term follow-up in only half of the patients in this series.
National Center for Biotechnology Information , U. Gruenberg , MD. Author information Copyright and License information Disclaimer. Corresponding author.
Address reprint request to: James C. This article has been cited by other articles in PMC. Abstract Background and Objective: To analyze patients with chronic acalculous cholecystitis over ten years, during which laparotomy was replaced by laparoscopy as the dominant operation for cholecystectomy in regard to patient demographics, diagnostic evaluations, follow-up symptoms, and additional operations.
Methods: Of cholecystectomies from June to June , patients had chronic acalculous cholecystitis. Results: Twice as many patients with chronic acalculous disease underwent cholecystectomy after the advent of laparoscopy. Conclusion: Chronic acalculous cholecystitis is a disease of white females, doubling in frequency over the decade of review.
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Keywords: Chronic acalculous cholecystitis, Laparoscopy, Gallbladder. Open in a separate window. Figure 1. Figure 2. References: 1.
Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy. Falling cholecystectomy thresholds since the introduction of laparoscopic cholecystectomy. Increased cholecystectomy rates among Medicare patients after the introduction of laparoscopic cholecystectomy.
J Comm Health. Chronic acalculous cholecystitis: laparoscopic treatment.
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Surg Laparosc Endosc. Results of surgical therapy for biliary dyskinesia. Arch Surg. Kinevac-assisted cholescintigraphy as an accurate predictor of chronic acalculous gallbladder disease and the likelihood of symptom relief with cholecystectomy. Am Surg. Abnormal gallbladder nuclear ejection fraction predicts success of cholecystectomy in patients with biliary dyskinesia.
Am J Surg. Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Cholecystikinin enhanced hepatobiliary scanning with ejection fraction calculation as an indicator of disease of the gallbladder. Surg Gynecol Obstet. Is gall bladder ejection fraction a reliable predictor of acalculous gall bladder disease?
Nuc Med Comm. Chronic acalculous gallbladder disease: a clinical enigma. W J Surg. Acalculous biliary pain: diagnosis and selection for cholecystectomy using the cholecystikinin test for pain reproduction. Br J Surg. Chronic biliary-type pain in the absence of gallstones: the value of cholecystokinin cholescintigraphy.
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Effect of cholecystikinin on colonic motility and symptoms in patients with the irritable-bowel syndrome. Altered sensitivity of the gallbladder to cholecystokinin octapeptide in irritable bowel syndrome.