Ratnakishore Pallapothu, MD, FACS, FASMBS1, Matthew Protas, MSIII2, Todd Prier, MD, FACS3, Jerome Brustein, MD3, Nirupama Anne, MD, FACS1. 1Our Lady of Lourdes Memorial Hospital, Binghamton, NY. SUNY Upstate Medical University, Binghamton Clinical Campus, Clinical Assistant Professor of Surgery., 2SUNY Upstate Medical University Syracuse NY, 3Our Lady of Lourdes Memorial Hospital, Binghamton, NY
Background: Biliary hyperkinesia is poorly understood and the diagnosis is questioned. The literature regarding surgical intervention for biliary hyperkinesia is limited. We present a case series of 41 patients who underwent laparoscopic cholecystectomy for biliary hyperkinesia and had symptomatic relief.
Methods: Patients presenting with symptoms of biliary colic, with a negative ultrasound for gallstones, underwent HIDA scan with CCK. Patients with ejection fraction (EF) greater than 80% were considered to have biliary hyperkinesia based on radiology literature. An IRB approval was obtained for a prospective study for the team comprising of surgeons and a radiologist. The study time was between March 2011- May 2018. 41 patients with ongoing refractory symptoms consistent with biliary colic, affecting quality of life, with negative upper GI work up (endoscopy), were considered for laparoscopic cholecystectomy. All the 41 patients were followed subsequently with postoperative follow up visits.
Results: 41 patients underwent laparoscopic cholecystectomy. 33 patients were women and 8 patients were men. 14 patients had EF between 80-90 % and 27 patients had EF between 90-100%. The chief complaint in all these patients was abdominal pain in epigastrium or right upper quadrant. The mean duration of symptoms is at least 6 months. The final histopathology showed cholecystitis in 32 patients; chronic cholecystitis (n= 31) and one patient had acute cholecystitis (n=1). Cholesterolosis in 11 patients and 8 patients had no pathologic findings. 40 patients had symptomatic relief and improved quality of life after surgical intervention. One patient had no change in her symptomatology. None of these patients had any postoperative complications.
Conclusion: There is enough evidence regarding the surgical intervention for symptomatic biliary hypo/dyskinesia (EF <35%). The literature regarding the diagnosis of biliary hyperkinesia which is defined as EF >80% is limited and most commonly misinterpreted as normal gall bladder function. Hence the diagnosis is missed and patients continue to have ongoing symptoms typical for biliary colic affecting the quality of life with multiple office and emergency room visits. Even though our number is limited, as demonstrated in our case series the entity of biliary hyperkinesia is true, as cholecystitis is noted in most pathology specimens (approximately 80%) and symptomatic response was noted in 98% of the patients with no postoperative complications. Hence cholecystectomy should be considered as an option for symptomatic patients with EF >80% when conservative measures such as life style and diet changes have failed and the symptoms become refractory.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93826
Program Number: P252
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster