Laparoscopic cholecystectomy for symptoms of biliary colic in the absence of gallstones

Background Acalculous cholecystitis is a controversial entity that accounts for 5% to 22% of cholecystectomies in some series. Multiple attempts have been made to find an objective clinical algorithm for diagnosis; however, we postulate that careful evaluation of clinical presentation is adequate to allow accurate diagnosis without reliance on ancillary tests, such as cholecystokinin-stimulated scintigraphy studies. Methods A retrospective chart review was made of all patients who underwent laparoscopic cholecystectomy at Cariboo Memorial Hospital between April 1997 and September 2001. Patients with history and physical examination consistent with biliary colic/cholecystitis, with negative ultrasonography scans, were reviewed and a telephone survey was conducted to determine subjective clinical outcomes. Results Eighty-eight patients were eligible for the study. Age range was 19 to 78 years. Eighty-three percent were female and 17% were male. Seventy-eight percent of patients had chronic symptoms, 17% acute, and 5% acute on chronic. Pathology reports indicated that 92% of gallbladders revealed disease and 8% were reported as normal. Two percent of patients had major complications postoperatively and 9% had minor complications. No deaths had occurred. Seventy-eight percent of procedures were performed as day surgeries, with an average hospital stay of 1.3 days. Mean follow-up was 25 months, with a range of 3 to 55 months. Ninety-one percent of patients were available for telephone survey follow-up. Forty-one percent of patients reported being “very satisfied” with the outcome of their surgery, 52% were “satisfied,” and 4% were “not satisfied.” Conclusions Acalculous cholecystitis is an entity that can be satisfactorily diagnosed by detailed history and physical examination with high patient satisfaction achieved after surgical management.