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Cholecystectomy - When and Why?

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Sośnik H., Sośnik K., Noga L.

Polish Journal of Surgery

2007

vol. 79

issue 10

649-655

The number of cholecystectomies is continuously increasing. However, the most beneficial period to perform surgery for gall-bladder pathologies has not been documented.The aim of the study. Based on pathomorphological changes in the gall-bladder wall, the aim of the study was to determine the optimal patient age for cholecystectomy.Material and methods. The study was comprised of 6356 surgically removed gall-bladders. Based on the analysis of microscopic specimens stained with hematoxylin and eosin, nine types of pathomorphological lesions were distinguished. These lesions were characterized from minimal changes to malignant neoplasms. Additionally, 2662 gall-bladders were examined to estimate the frequency of dysplasia and were classified from stage one to three. The occurrence of particular types of dysplasia correlated with patient age and gender. The results were subjected to statistical analysis. p≤0.05 was considered statistically significant.Results. The female patients were subjected to surgical intervention 3.2 times more frequent than male patients. The average female patient age was significantly lower (53.3±14.2 years) relative to male subjects (57.3±13.3 years) (p=0.001). For men, the lowest average age for patients with minimal gall-bladder wall lesions that were significantly different from the mean patient age with exacerbation of chronic (p=0.001) and gangrenous cholecystitis was 54.41±13 years (p=0.001). For female patients, the lowest mean age of patients with minimal changes that were significantly different from the average age of the remaining pathomorphological lesion subgroups was 50.11±14.12 years. The mean age of male patients with gall-bladder carcinoma exceeded that of patients with minimal lesions by ten years (p=0.002) and female patients by 18 years (p=0.001).68% of operated women were aged between 41 and 70 years. Most cases (76.9%) concerned subjects with minimal lesions (36.4%), chronic cholecystitis (24.9%), and exacerbation of chronic cholecystitis (13.5%). Gall-bladder dysplasia was observed in 36.7% of cases: first degree - 25.9%, second degree - 9.4%, and third degree - 1.43%. The occurrence of the above-mentioned pathologies significantly correlated with the age of operated patients. Dysplasia was diagnosed in 22.8% of cases under the age of thirty. Gender had no significant influence on the occurrence of dysplasia.The late occurrence of exacerbated chronic and gangrenous cholecystitis (51-70 years), and early occurrence of mucous membrane dysplasia, especially third degree, implicates the need for surgical intervention in the management of cholelithiasis.Conclusion. Based on the examination of pathomorphological lesions and the literature, the most beneficial period to perform surgery, especially by means of laparoscopy is during the fifth decade of life.

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1 Polish Journal of Surgery

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Cholecystectomy - When and Why?