Abstract
Background
A gallbladder ejection fraction (EF) on cholescintigraphy of less than 35% after cholecystokinin (CCK) has been considered to be pathophysiologic and an indication for laparoscopic cholecystectomy (LC).
Methods
All patients undergoing LC for biliary dyskinesia between 1994 and 2001 were prospectively entered into a database. These patients were retrospectively evaluated with regard to demographics, the number of preoperative studies obtained, postoperative symptoms, and the number of postoperative studies obtained.
Results
Sixty patients underwent LC for biliary dyskinesia. The mean gallbladder EF was 14%, and 75% of patients were asymptomatic postoperatively. Persistent symptoms prompted further investigation in 6% of patients with a gallbladder EF <14% and in 35% of patients with an EF between 14 and 35% (p = 0.05).
Conclusion
Laparoscopic cholecystectomy alleviated symptoms in 94% of patients with a gallbladder EF <14% after CCK injection. The diagnostic significance of a preoperative CCK cholescintigram (EF 14–35%) needs further investigation.
Similar content being viewed by others
References
DB Adams PR Tamasky RH Hawes JT Cunningham C Brooker TE Brothers PB cotton (1998) ArticleTitleOutcome after laparoscopic cholecystectomy for chronic acalculous cholecystitis. Am Surg 64 1–5 Occurrence Handle1:STN:280:DyaK1c7hvVWntw%3D%3D Occurrence Handle9457029
A Blalock (1924) ArticleTitleA statistical study of eight hundred and eighty-eight cases of biliary tract disease. Johns Hopkins Hosp Bull 35 391–409
AJ Canfield SP Hetz JP Schriver HT Servis TL Hovenga PT Cirangle BS Burlingame (1998) ArticleTitleBiliary dyskinesia: a study of more than 200 patients and review of the literature. J Gastrointest Surg 2 443–448 Occurrence Handle10.1016/S1091-255X(98)80035-8 Occurrence Handle1:STN:280:DyaK1M%2FlvF2qsw%3D%3D Occurrence Handle9843604
PF Chen A Nimeri QH Pham JN Yuh JR Gusz RS Chung (2001) ArticleTitleThe clinical diagnosis of chronic cholecystitis. Surgery 130 578–581
D Fink-Bennett P DeRidder WZ Kolozsi R Gordon R Jaros (1991) ArticleTitleCholecystokinin cholescintigraphy: detection of abnormal gallbladder motor function in patients with chronic acalculous gallbladder disease. J Nucl Med 32 1695–1699 Occurrence Handle1:STN:280:By6A2cbosFw%3D Occurrence Handle1880571
P Frasinelli M Werner JF Reed Suffix3rd C Scagliotti (1998) ArticleTitleLaparoscopic cholecystectomy alleviates pain in patients with acalculous biliary disease. Surg Lap Endosc Perc Tech 8 30–34 Occurrence Handle10.1097/00019509-199802000-00008
JB Friedman WN Cohen (1975) ArticleTitleCholecystokinin cholangiography and analysis of duodenal bile in the investigation of pain in the right upper quadrant of the abdomen without gallstones. Surg Gynecol Obstet 140 371–376 Occurrence Handle1:STN:280:CSqC3c3psVI%3D Occurrence Handle1090019
DB Jones NJ Soper JD Brewer MA Quasebath PE Swanson SM Strasberg LM Brunt (1996) ArticleTitleChronic acalculous cholecystitis: laparoscopic treatment. Surg Lap Endosc Perc Tech 6 114–122 Occurrence Handle10.1097/00019509-199604000-00006 Occurrence Handle1:STN:280:BymB28bgvFM%3D
K Jones-Monahan JC Gruenberg (1999) ArticleTitleChronic acalculous cholecystitis: changes in patient demographics and evaluation since the advent of laparoscopy. J Soc Laparoendosc Surg 3 221–224 Occurrence Handle1:STN:280:DyaK1MvlsVCmuw%3D%3D
R Kloiber CP Molnar EA Shaffer (1992) ArticleTitleChronic biliary-type pain in the absence of gallstones: the value of cholecytokinin cholescintigraphy. Am J Roentgenol 159 509–513 Occurrence Handle1:STN:280:By2A28jmsFw%3D
GT Krishnamurthy VR Bobba K Langrell (1984) ArticleTitleThe gallbladder emptying response to sequential exogenous and endogenous cholecystokinin. Nucl Med Commun 5 27–33 Occurrence Handle1:CAS:528:DyaL2cXhs1ykt74%3D Occurrence Handle6543926
AR Merg SE Kalinowski MM Hinkhouse FA Mitros KS Ephgrafe JJ Cullen (2002) ArticleTitleMechanisms of impaired gallbladder contractile response in chronic acalculous cholecystitis. J Gastrointest Surg 6 432–437 Occurrence Handle10.1016/S1091-255X(01)00061-0 Occurrence Handle12022997
V Raptopoulos CC Compton P Doherty EH Smith CJ D’Orsi NA Patwardhan R Goldberg (1986) ArticleTitleChronic acalculous gallbladder disease: multiimaging evaluation with clinical–pathologic correlation. Am J Roentgenol 147 721–724 Occurrence Handle1:STN:280:BimA3MbnslA%3D
RP Sarva DP Shreiner D Thiel ParticleVan N Yingvorapant (1985) ArticleTitleGallbladder function. Methods for measuring filling and emptying. J Nucl Med 26 140–146 Occurrence Handle1:STN:280:BiqC3cjivVY%3D Occurrence Handle3968578
WH Schwesinger AK Diehl (1996) ArticleTitleChanging indications for laparoscopic cholecystectomy. Stones without symptoms and symptoms without stones. Surg Clin North Am 76 493–504 Occurrence Handle1:STN:280:BymB283is1Q%3D Occurrence Handle8669009
J Tabet M Anvari (1999) ArticleTitleLaparoscopic cholecystectomy for gallbladder dyskinesia: clinical outcome and patient satisfaction. Surg Lap Endosc Perc Tech 9 382–386 Occurrence Handle10.1097/00019509-199912000-00002 Occurrence Handle1:STN:280:DC%2BD3czivFSiuw%3D%3D
PJ Westlake NB Hershfield JK Kelley R Kloiber R Lui LR Sutherland EA Shaffer (1990) ArticleTitleChronic right upper quadrant pain without gallstones: does HIDA scan predict outcome after cholecystectomy? Am J Gastroenterol 85 986–990 Occurrence Handle1:STN:280:By%2BA38fhslU%3D Occurrence Handle2375327
AO Whipple (1926) ArticleTitleSurgical criteria for cholecystectomy. Am J Surg 40 129–139
L Yap AG Wycherley AD Morhett J Toouli (1991) ArticleTitleAcalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology 101 786–793 Occurrence Handle1:STN:280:By6A3Mjkt1I%3D Occurrence Handle1860640
F Yost J Margenthaler M Presti F Burton K Murayama (1999) ArticleTitleCholecystectomy is an effective treatment for biliary dyskinesia. Am J Surg 178 462–465 Occurrence Handle1:STN:280:DC%2BD3c7jsVeisQ%3D%3D Occurrence Handle10670853
HA Ziessman (2001) ArticleTitleCholecystokinin cholescintigraphy. Clinical indications and proper methodology. Rad Clin North Am 39 997–1006 Occurrence Handle1:STN:280:DC%2BD3MrktVyitA%3D%3D
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bingener, J., Richards, M.L., Schwesinger, W.H. et al. Laparoscopic cholecystectomy for biliary dyskinesia. Surg Endosc 18, 802–806 (2004). https://doi.org/10.1007/s00464-003-8145-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-003-8145-6