SS  Vol.3 No.1 , January 2012
An Alternative Approach to Sending All Gallbladders for Histology Following Cholecystectomy?
Abstract: Background: The question of a selective approach to sending all gallbladders for histology following cholecystectomy has been postulated in many journals but as yet no guidelines have been published in light of such concern. This project will attempt to analyse and address the controversy surrounding sending all gallbladders for histology following cholecystectomy. Objective: To ascertain whether there is a feasible and safe alternative to sending all gallbladders to histology following cholecystectomy and to challenge such a hypothesis. Design: Retrospective study. Methods: Analysis of gallbladder pathology reports, patient medical records and computerised test results from cholecystectomies done in the last 5 years within the Lancashire Teaching Hospital Trust. Results: The alternative selective method based on pre-operative investigations and intra-operative macroscopic detail is shown to be significant (P < 0.05). Conclusion: The results from this study show that there is safe and efficient way of selecting which gallbladders are sent for histology based on age, pre-surgical suspicion and intra-operative macroscopic abnormalities.
Cite this paper: J. Byars and K. Pursnani, "An Alternative Approach to Sending All Gallbladders for Histology Following Cholecystectomy?," Surgical Science, Vol. 3 No. 1, 2012, pp. 15-20. doi: 10.4236/ss.2012.31003.

[1]   C. M. Lam, A. W. Yuen, A. C. Wai, R. M. Leung, A. Y. Lee, K. K. Ng, et al., “Gallbladder Cancer Presenting with Acute Cholecystitis. A Population-Based Study,” Surgical Endoscopy, Vol. 19, No. 5, 2005, pp. 697-701. doi:10.1007/s00464-004-9116-2

[2]   P. Cubertafond, M. Mathonnet, A. Gainant and B. Launois, “Radical Surgery for Gallbladder Cancer. Results of the French Surgical Society Survey,” Hepato-Gastroenterology, Vol. 46, No. 27, 1999, pp. 1567-1571.

[3]   N. A. Collier and L. H. Blumgart, “Tumours of the Gall- bladder,” In: L. H. Blumgart, Ed., Surgery of the Liver and Biliary Tract, 2nd Edition, Churchill Livingstone, New York, 1994, pp. 55-66.

[4]   E. Yildirim, O. Celen, K. Gulben and U. Berberoglu, “The Surgical Management of Incidental Gallbladder Carcinoma,” European Journal of Surgical Oncology, Vol. 31, No. 1, 2005, pp. 45-52. doi:10.1016/j.ejso.2004.09.006

[5]   M. I. M. De Zoysa, S. K. L. A. De Silva and A. Illiperuma, “Is Routine Histological Examination of the Gallbladder Specimens Justifiable?” Ceylon Medical Journal, Vol. 55, No. 1, 2010, pp. 3-16. doi:10.4038/cmj.v55i1.1702

[6]   H. Gapaul, D. A. O’Reilly, J. Evans and D. Monk, “Is Routine Histology Part of ‘a Perfect Cholecystectomy’?” British Journal of Surgery, Vol. 94, 2007, pp. 57-58.

[7]   S. Mahmud, B. Darmas, A. Abbass, S. Paravastu, C. V. Rao and A. L. Baker, “Is There a Justification for Routine Histological Examination of the straightforward Cholecystectomy Specimens,” British Journal of Surgery, Vol. 93, 2006, p. 117.

[8]   R. Mittal, M. R. Jesudason and S. Nayak, “Selective Histopathology in Cholecystectomy for Gallstone Disease,” Indian Journal of Gastroenterology, Vol. 29, No. 5, 2010, pp. 26-30. doi:10.1007/s12664-010-0056-6

[9]   J. M. Piehler and R. W. Crichlow, “Primary Carcinoma of the Gallbladder,” Surgery Gynecology & Obstetrics, Vol. 147, 1978, pp. 929-942.

[10]   J. Y. Jang, S. W. Kim, S. E. Lee, D. W. Hwang, E. J. Kim, J. Y. Lee, S. J. Kim and Y. T. Kim, “Differential Diagnosis and Staging Accuracies in High Resolution Ultrasonography, Endoscopic Ultrasonography and Multidetector Computed Tomography for Gallbladder Polyploid Lesions and Gallbladder Cancer,” Annals of Surgery, Vol. 250 No. 6, 2009, pp. 943-949

[11]   D. Levy, L. A. Murakata and C. A. Rohrmann, “Gallbladder Carcinoma: Radiological-Pathological Correlation,” Radiographics, Vol. 21, No. 2, 2001, pp. 295-314.

[12]   S. P. Shih, R. D. Schulick, J. L. Cameron, K. D. Lillemoe, H. A. Pitt, M. A. Choti, K. A. Campbell, C. J. Yeo and M. A. Talamini, “Gallbladder Cancer: The Role of Laparoscopic and Radical Resection,” Annals of Surgery, Vol. 250, No. 3, 2009, p. 495.

[13]   D. Morris-Stuff, J. Roche, M. E. Foster and M. H. Lewis, “The Incidence of Incidental Gallbladder Carcinoma Has Not Increased in the Laparoscopic Cholecystectomy Era,” British Journal of Surgery, Vol. 95, Suppl. 7, 2008, p. 16.

[14]   T. Wakai, Y. Shirai, N. Yokoyama, S. Nagakura, H. Watanabe and K. Hatakeyama, “Early Gallbladder Carcinoma Does Not Warrant Radiacal Resection,” British Journal of Surgery, Vol. 88, No. 5, 2001, pp. 675-678. doi:10.1046/j.1365-2168.2001.01749.x

[15]   D. Roy, S. K. C. Toh, S. S. Somers, A. M. Walters and S. A. Sadek, “Value of Histology in a High-Volume Cholecystectomy Unit,” British Journal of Surgery, Vol. 92, Suppl. 1, 2005, pp. 56-63.

[16]   L. E. Matthyssens, M. Ziol, C. Barrat and G. G. Champault, “Routine Surgical Pathology in General Surgery,” British Journal of Surgery, Vol. 93, 2006, pp. 362-368. doi:10.1002/bjs.5268

[17]   F. P. Dix, I. A. Bruce, A. Krypcyzk and S. Ravi, “A Selective Approach to Histopathology of the Gallbladder Is Justifiable,” Journal of the Royal Colleges of Edinburgh and Ireland, 2003, pp. 233-323.

[18]   Reference for Income for a Histopathologist in the UK

[19]   M. S. Khuroo, R. Mahajan, S. A. Zargar, G. Javid and S. Sapru, “Prevalence of Biliary Tract Disease in India: A Sonographic Study in Adult Population in Kashmir,” GUT, Vol. 30, No. 2, 1989, pp. 201-205.

[20]   G. M. Scarnecki, I. G. Karol and H. Khalil, “Gallbladder Carcinoma,” 2011.

[21]   J. C. E. Underwood, “A Recovery Plan for Histopathology,” Royal College Pathology Bulletin, Vol. 113, 2001, pp. 12-14.