We report on our experience with
laparoscopic cholecystectomy in 15 patients, 12 females and 3 males (mean age: 44 years), with chronic
acalculous cholecystitis. These patients presented with recurrent episodes of biliary
colic together with a dysmorphic or dysfunctioning gallbladder as confirmed by ultrasound and/or cholescintiscan with 99m-Tc
HIDA performed in fasting conditions and after meals. First of all, we considered the possible presence of concomitant digestive disease (
peptic ulcer disease, recurrent
pancreatitis,
irritable bowel syndrome,
chronic hepatitis) potentially responsible for the
pain. Ultrasound investigations revealed a pathological gallbladder in 10 patients.
Cholecystectomy was curative in 8/10. Cholescintiscan revealed a pathological gallbladder in 8 patients and
cholecystectomy was curative in only 5 of these. No postoperative deaths or significant complications occurred. The mean duration of the operation (35 vs 48 min) and
hospital stay (2.1 vs 2.8 days) were reduced in comparison to 346
cholecystectomies performed for
gallstones. After 6-36 months' follow-up, resolution of symptoms was successful in 10/15 cases (66.6%); in 3 cases, only
dyspepsia was reduced, whilst in the other 2 cases, who also presented concomitant
irritable bowel syndrome and gastroduodenitis, there was no improvement in
pain. In all but the latter two cases (86.6%), histological examination revealed chronic
gallbladder inflammation. In conclusion,
laparoscopic cholecystectomy was curative (66.6%) or led to an improvement in symptoms (20%) in patients with chronic acalculous cholcystitis. Cholescintiscans were not always diagnostic for the disease, whereas ultrasound findings were more useful as an indication for surgery.