Is there a need for lap chole with hyperkinetic gallbladders?

Introduction/Purpose: Classic biliary dyskinesia has been defined as an ejection fraction less than 35% during hepatobiliary scan with cholecystokinin. There are a subset of patients who present with symptoms of biliary colic and what appears to be biliary hyperkinesia, or an ejection fraction greater than 75%. There is little data concerning these patients with elevated ejection fraction, and resolution or recurrence of their symptoms in the postoperative period.

Methods or Case Description: A retrospective chart review was completed on all patients >18 years, who had symptoms consistent with biliary colic, an ejection fraction >/= 75% on hepatobiliary scan and underwent a laparoscopic cholecystectomy between August 1, 2015 and October 31, 2019. The total number of patients identified was 60. Patients with gallstones were excluded from the study.

Outcomes: All 60 patients in our review had pathology consistent with chronic cholecystitis, and 18 of those showed chronic cholecystitis with cholesterolosis. We retrospectively chart reviewed the post-operative information concerning resolution of preoperative symptoms. We were able to confidently identify 45 out of 60 patients (75%) that reported complete resolution of symptoms. 14 out of 60 had partial resolution and 1 patient reported no resolution. With this data, 59 out of 60 patients reported noticeable improvement in their pre-operative symptoms.

Conclusion: According to the data from our study, we would conclude that there is indication for laparoscopic cholecystectomy in patients with hyperkinetic gallbladders. The range we used was >75% which is an easy cutoff for use in practice. Surgery would be an adequate option to offer patients presenting with biliary colic and EF >75%, especially in the setting of other negative diagnostic workup.