Robert C Wright, MD, FACS, Rachel Robles, Haley Peffer, Nina Thach, Robert J Wright. Meridian Surgery Center
BACKGROUND: Clinical response of patients with symptomatic biliary colic but with atypical findings of gallbladder polyps, hyper-dynamic gallbladder and otherwise negative biliary work up are underrepresented in the literature.
METHODS: A clinical outcome study with a retrospective design compared the pre-operative pain to the post-operative pain reported by patients with pre-operatively diagnosed biliary dyskinesia to all other patients with biliary colic and atypical pre-operative diagnoses. A visual analog scale was used. All patients underwent surgery at Meridian Surgery Center from the years 2010 to 2017. 600 patients were reviewed for biliary dyskinesia, gallbladder polyps, hyper-dynamic gallbladder and negative work up. Patients with cholelithiasis or sludge were excluded from the study. Post-operative pathology reports were reviewed.
RESULTS: Responses were received from 17 biliary dyskinesia patients, 10 hyper-dynamic patients, 10 polyps patients, 3 adenomyosis patients and 9 negative work up patients. Based on a 10 point pain scale, we found a mean drop in pain scale among biliary dyskinesia patients (-5.6) and among all other atypical findings (-5.7), with -6.1 for hyper-dynamic patients, -5.7 for adenomyosis patients, -6.0 for polyps patients and -5.0 for negative work up patients. There is no significant difference between pain recovery of patients with biliary dyskinesia and those with another atypical diagnosis. From the surgical pathology reports, all 17 of the of the biliary dyskinesia patients had chronic cholecystitis. Similarly, 9 hyper-dynamic patients, 10 polyps patients, 9 negative work up patients and 3 adenomyosis patients had chronic cholecystitis. Only 2 of the polyp patients’ pathology reports showed polyps. Gallstones were reported in 2 biliary dyskinesia patients, 1 hyper-dynamic patient and 2 of the 3 adenomyosis patients. One patient had a completely normal report was in the hyper-dynamic group. Our poor response rates were disappointing.
CONCLUSION: These results allow us to conclude that there is a comparable surgical pain relief between biliary colic patients with gallbladder polyps, hyper-dynamic gallbladder, negative work up and those with conventional biliary dyskinesia.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95480
Program Number: P232
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster