Laparoscopic cholecystectomy for an abnormal hepato-iminodiacetic acid scan: A worthwhile procedure

Patients with symptoms similar to symptomatic cholelithiasis but with no so nographic evidence of gallstones can be difficult to manage. Cholecystokini n (CCK)-stimulated hepatobiliary scans can be helpful in determining whethe r the biliary tract is the potential source of the symptoms, We retrospecti vely reviewed the medical records of 69 patients at our institution who und erwent CCK-stimulated hepatobiliary scans over a 2-year period. Twenty-nine of 69 patients had an abnormal gallbladder ejection fraction (defined as 3 5% or less). All 29 patients had no sonographic evidence of cholelithiasis. Seventeen of the 29 underwent cholecystectomy. There were no complications or deaths within the operative group. Fifteen of the pathologic specimens had evidence of chronic cholecystitis, one was cytomegalovirus cholecystiti s, and one showed only cholesterolosis, There was no other intraperitoneal pathology to explain the abdominal symptoms. At an average follow-up of II months, eight patients (47%) in the operative group had complete resolution of their symptoms, six (35%) had significant improvement, two (12%) were u nchanged, and one (6%) was worse. Twelve of 29 patients did not have a chol ecystectomy, At an average follow-up of II months, four (33%) of these pati ents had improvement and eight (66%) reported no change or worsening of the ir symptoms. In the operative group, 53 per cent had reproduction of their symptoms with CCK stimulation, and in the nonoperative group, 33 per cent r eported symptoms. Average gallbladder ejection fraction was 10 per cent (ra nge, 0-32) in the operative group and 23 per cent (range, 0-35) in the nono perative group. Liver function tests were similar in each group, CCK-stimul ated hepatobiliary scans were helpful in defining biliary tract disease in patients without gallstones. These patients may benefit from cholecystectom y with minimal risk of morbidity and mortality.