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Chronic Acalculous Cholecystitis the Cariboo Memorial Hospital Experience

Background. Biliary

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Chronic Acalculous Cholecystitis the Cariboo Memorial Hospital Experience

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    1. Chronic Acalculous Cholecystitis the Cariboo Memorial Hospital Experience Jeff Demetrick Dan Brosseuk

    2. Biliary “type” pain in the face of negative USS Differential Diagnosis False negative USS vs UGI pathology vs other pathology Spectrum of investigations include: UGI series, endoscopy CT Scan, HIDA scan, IVP Pts with strong clinical suspicion and no other pathology identified are offered the option of Conservative Management vs Laparoscopic Cholecystectomy Previous investigators have predicated treatment options on the results of HIDA scan and CCK stimulated ejection fractions

    3. Retrospective Chart Review and Telephone Survey All pts operated on for Acalculous Cholecystitis at CMH April 1997 - Sept 2001 were reviewed All surgeries performed by 2 surgeons Telephone Survey by non-surgical staff to assess pt satisfaction Where pt outcomes could not be fully assessed by Hospital and Office chart review - questioning was included in telephone survey

    4. Demographics 755 cholecystectomies performed in study period 88 pts included in study (12% of cholecystectomies) 15 Male : 73 Female Age range 19 - 78 (mean age 42 yrs) 69 pts (78%) performed as daycare 19 pts admitted with avg length of stay 2.8 days Avg length of stay for all pts 1.3 days

    5. Symptom duration 15 Acute (17%) - unremitting symptoms of less than 2 weeks duration 69 Chronic (78%) 4 Acute on Chronic (5%) Other Investigations 36 gastroscopies, 12 had 2 or more USS 5 barium UGI, 2 HIDA scan, 1 CT scan, 3 colonoscopies, 1 IVP Surgery Performed 71 Laparoscopic Cholecystectomy (81%) 12 Laparoscopic Cholecystectomy + cholangiogram (14%) 5 Laparoscopic Cholecystectomy + other procedure (6%) 1 posterior repair, 1 lysis of adhesions, 1 oophorectomy, 1 appendectomy, 1 foot ganglion

    6. Pathology 61 Chronic Cholecystitis (69%) 10 Chronic Cholecystitis + cholelithiasis (11%) 2 Subacute Cholecystitis (2%) 1 Acute Cholecystitis (1%) 2 Acute on Chronic Cholecystitis (2%) 2 Cholesterolosis (2%) 1 Cholesterolosis + Chronic Cholecystitis (1%) 1 “Thick Gallbladder wall” (1%) 1 Sludge (1%) 7 Normal Gallbadder (8%)

    7. 0 conversions to open procedure 0 intra-operative complications Minor 9% 2 exacerbation of diarrhea 3 wound infections 1 nausea 1 port site bleed 1 port site hernia Major 2% 1 post anesthetic Guillane Barre Syndrome 1 cystic duct stump leak

    8. 7 pts lost to follow-up (91% available for follow-up) 36 (44%) “very satisfied” 42 (52%) “satisfied” 3 (4%) “not satisfied”

    9. All 3 “not satisfied” had pathology: 3 chronic cholecystitis - 1 with stones 2 had complications - 1 port site hernia, 1 cystic duct stump leak Of the 7 pts with “Normal Pathology” 3 very satisfied 3 satisfied 1 lost to followup Both pts with Major Complications had pathological gallbladders 1 was “satisfied” and 1 “not satisfied”

    10. Acalculous Cholecystitis is a pathological disease which can be accurately diagnosed clinically based on careful history and physical exam after excluding other pathology Comparing our results to the literature (ie Chen et al - Surgery Oct 01) other diagnostic modalities such as HIDA-CCK do not increase diagnostic accuracy

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