CHRONIC ACALCULOUS CHOLECYSTITIS - LAPAROSCOPIC TREATMENT

From 1990 through 1993, we treated 36 patients with recurrent typical biliary colic but who showed no ultrasonic evidence of cholelithiasis by laparoscopic cholecystectomy. Associated symptoms included nausea ( 75%), bloating (56%), fatty-food intolerance (53%), vomiting (17%), we ight loss (31%), bowel irregularity (28%), reflux or dyspepsia (25%), and fever (17%). Diagnostic evaluation included ultrasound (100%), upp er gastrointestinal series (36%), oral cholecystogram (14%), computed tomographic scan (39%), endoscopic retrograde cholangiopancreatography (17%), upper gastrointestinal endoscopy (14%), and hepatobiliary scan (92%). Quantitative hepatobiliary scans in 33 patients revealed a low gallbladder ejection fraction (EF) of less than 35% in 29 patients (8 8%; mean EF = 9%), and 13 patients experienced reproducible pain after cholecystokinin provocation. All patients underwent attempted laparos copic cholecystectomy; one case of unsuspected acute acalculous cholec ystitis was converted to open laparotomy because of unclear anatomy. G ross and histological examination of the gallbladders revealed chronic inflammation (83%), cholesterolosis (31%), cholesterol crystals or sm all stones (17%), acute inflammation (8%), polyps (6%), and normal his tology (6%); however, blind retrospective scoring of gallbladders reve aled significant chronic inflammation in only 38%. In the 2 to 40 mont hs (mean, 14 months) since operation, there have been no deaths (97% f ollow-up). Laparoscopic cholecystectomy relieved pain in 93% of patien ts with a low preoperative EF compared with 75% of patients with a nor mal EF (nonsignificant p value). Persistent abdominal or gastrointesti nal complaints included flatulence (31%), loose stools or fecal urgenc y (29%), belching (29%), indigestion (20%), nausea (11%), and ''typica l'' gallbladder pain (9%). We conclude that many patients with symptom s of biliary colic and scintigraphic evidence of biliary dyskinesia ha ve histologic findings of chronic cholecystitis. Although laparoscopic cholecystectomy usually eliminates biliary colic, persistent nonbilia ry complaints are frequent.