IMPORTANCE OF ACCURATE PREOPERATIVE DIAGNOSIS AND ROLE OF ADVANCED LAPAROSCOPIC CHOLECYSTECTOMY IN RELIEVING CHRONIC ACALCULOUS CHOLECYSTITIS

Between April 1, 1989, and January 1; 1994, 38 patients with chronic a calculous cholecystitis underwent an advanced (3-puncture) laparoscopi c cholecystectomy at our institution. The 30 women and 8 men had a mea n age of 39 years (range, 23 to 65 years) and represented 4.5% of our overall gallbladder patient population. In each case, the disease prod uced typical biliary colic, but no gallstones were visualized on ultra sound examination; cholecystokinin-stimulated cholescintigraphy reveal ed a dysfunctional gallbladder, as evidenced by an ejection fraction o f less than or equal to 35% or nonvisualization or nonemptying of the organ. In all 38 cases, cholecystectomy resulted in the complete relie f of symptoms. Although an increasing number of physicians are recomme nding this operation for acalculous gallbladder disease, it should not be performed on the basis of clinical history alone. Rather, objectiv e criteria confirming the need for surgical intervention should be obt ained by means of appropriate preoperative testing, including cholecys tokinin-stimulated cholescintigraphy.