Cholecystectomy for gall bladder dyskinesia: symptom resolution and satisfaction in a rural surgical practice.
BACKGROUND
Gall bladder dyskinesia describes a clinical entity with symptoms of biliary colic but without objective evidence of gallstones. Recent work has suggested laparoscopic cholecystectomy as an effective treatment although this approach has not gained widespread acceptance in Australia.


METHODS
At the sole nuclear medicine facility in Mildura, Victoria, a retrospective search of patients with gallbladder ejection fractions </=35% on CCK-HIDA (cholecystokinin-99mTc hepatoiminodiacetic acid) scanning over a 3-year period from 1 January 1998 was undertaken. Twenty-eight patients proceeded to cholecystectomy by the author and case notes were reviewed for symptoms, preoperative investigation, operation, pathology and complications. Telephone follow-up was carried out assessing symptom response and overall satisfaction following operation.


RESULTS
Follow up was achieved in 100% of patients with a mean duration of 18 months. Twenty-five of 28 underwent chole-cystectomy by laparoscopic approach and there were no complications in the series. All gall bladders demonstrated an abnormality at histology. Overall, 79% of patients had some symptom improvement at follow-up with 29% completely symptom free. Six patients (21%) were not improved following cholecystectomy. Overall satisfaction was high with a median 8/10.


CONCLUSIONS
Laparoscopic cholecystectomy is recommended for gallbladder dyskinesia diagnosed on CCK-HIDA scanning, after other causes have been excluded and informed discussion regarding incomplete symptom resolution has been undertaken. Improvement without operation occurs only in the minority and is rarely complete. Cholecystectomy affords at least partial symptom relief in the majority with high levels of patient satisfaction.
Gall
Carey Andrew
CA
Department of Surgery, Mildura Base Hospital, Mildura, Victoria, Australia.
Chambers
Kevin John
KJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001657:Biliary Dyskinesia / Q000601:surgery*; D002763:Cholecystectomy; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D016896:Treatment Outcome; D014739:Victoria