Methods
All patients who underwent a laparoscopic cholecystectomy at the Department of Surgical Sciences, Organ Transplantation and Advanced Technologies of University of Catania - Cannizzaro Hospital from 1999 to 2008 were retrospectively analyzed after approval of hospital ethics committee. Data were collected from medical records and patients were analyzed depending on the symptoms at admission and diagnosis at discharge in order to find the percentage of patients admitted and subsequently operated on with no indication. Patients operated with open technique and those who experienced a conversion to laparotomy were not considered for the present study.
Patient preoperative assessment was performed according the standard of care in our practice by routine laboratory tests and ultrasound (US). Computed tomography (CT) scan was performed only in cases of unclear diagnosis.
Patients who were diagnosed for gallstones at FAST and subsequently operated on at the resolution of the main cause of admission were also included in the present study.
Diagnosis of acute cholecystitis was based on the presence of right upper quadrant pain with or without fever and with evidence of raised WBC count, ultrasonographic evidence of gallstones, pericholecystic fluid collection, gall bladder wall thickness and thick wall contracted gall bladder.
According to the evidences in literature, conditions that were considered correct indications for surgery were the following: acute cholecystitis (including complicated form such as gallbladder perforation and gangrene), acute biliary pancreatitis, gallbladder adenomas, cholangitis with evidence of gallstones, biliodigestive fistula and Mirizzi syndrome, lithiasis of the biliary ducts with or without jaundice, recurrent episodes of biliary colic or recurrent jaundice and the rare Bouveret syndrome. Conversely, medical records of patients who were admitted only because of the general diagnosis of abdominal pain with gallstones, or patients without symptoms in which diagnosis was performed incidentally during FAST exam for trauma were further analyzed in order to find the percentage of patients operated on without indication.
The following parameters were considered: sex, age, presence of comorbidities (diabetes mellitus, hepatic cirrhosis, and immunosuppression), pre-and postoperative stay, length of hospitalization, history of previous biliary colic or jaundice, symptoms referred at the admission, diagnostic imaging performed, white blood cell count and bilirubin levels at the admission.
Patients with gallstones and vague abdominal pain with atypical localization or characteristics, who underwent an operation for gallbladder stones without previous episodes of pain, jaundice, increase in WBC count or bilirubin were considered as operated on without indication. These patients were subsequently contacted by telephone and an oral questionnaire was administered in order to assess the percentage of those who experienced early (within 30 days) or delayed recurrence of symptoms, as well as those who had no improvement in symptoms despite the operation.
Local Ethics Committee Who Gave Approval for the Study
Cannizzaro Hospital Ethics Commettee.