Cholecystectomy - When and Why?
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.
- Lowenfels AB: Gallstones and the risk of cancer. Gut 1980; 21: 1090-92.[Crossref][PubMed]
- Bateson M C: Gallstones and cholecystectomy in modern Britain. Postgrad Med J 2000; 76: 700-03.[Crossref][PubMed]
- Sośnik H, Sośnik K, Noga L: Cholelithiasis - cholecystectomy - colorectal carcinoma. Autopsy material analysis. Pol Przegl Chir 2005; 77: 1266-75.
- Sośnik H, Sośnik K, Noga L: Cholelithiasis and body weight. Statistical analysis considering the autopsy material. Gastroenterologia Pol 2006; 13: 177-180.
- Fobi M, Lee H, Igwe D, et al.: Prophylactic cholecystectomy with gastric bypass operation: incidence of gall-bladder disease. Obesity Surgery 2002; 12: 350-53.[Crossref][PubMed]
- Urban A, Papla B: Carcinoma of the gall-bladder in the early stage of development and concurrent changes in the mucosa. (in polish). Pat Pol 1984; 35: 137-52.
- Ho H S, Matiesen KA, Wolfe BM: The impact of laparoscopic cholecystectomy on the treatment of symptomatic cholelithiasis. Sur Endosc 1996; 10: 746-50.[Crossref]
- Patino J F, Quintero GA: Asymtomatic cholelithiasis revisited. World J Surg 1998; 22: 1119-24.
- Ransohoff F, Gracie WA, Wolfenson LB, et al.: Prophylactic cholecystectomy or expectant management for silent gallstones. Ann Int Med 1983; 99: 199-04.[Crossref]
- Albores- Saavedra J, Alcantra- Vazquez A, Cruz-Ortiz H, et al.: The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer 1980; 45: 919-27.[Crossref]
- Sośnik K, Sośnik H: Cholecystectomy in the prevention of gall-bladder carcinoma. Pol Przegl Chir 2006; 78: 690-700.
- Friedman GD: Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993; 165: 399-04.[PubMed][Crossref]
- Johanning JM, Gruenberg JC: The changing face of cholecystectomy. Am Surg 1998; 64: 643-48.[PubMed]
- McMahon AJ, Fischbacher CM, Frame S, et al.: Impact of laparoscopic cholecystectomy: a population - based study. Lancet 2000; 356: 1632-37.[Crossref]
- Nair RG, Dunn DC, Fowler S, et al.: Progress with cholecystectomy: improving results in England and Wales. Brit J Sur 1997; 84: 1396-98.
- Legorreta AP, Silber JH, Costantino GN, et al.: Increased cholecystectomy rate after the intraduction of laparoscopic cholecystectomy. JAMA 1993; 270: 1429-32.[Crossref]
- Urban A, Papla B, Szczudrawa J: Pathomorphological changes in the gall-bladder due to cholelithiasis and cholecystitis (in polish). Pat Pol 1985; 36: 130-53.
- Dowling GP, Kelly JK: The histogenesis of adenocarcinoma of the gall-bladder. Cancer 1986; 58: 1702-08.[PubMed][Crossref]
- Yoshida S, Ohta J, Yamasaki K, et al.: Effect of surgical stress on endogenous morphine and cytokine levels in the plasma after laparoscopic or open cholecystectomy. Surg Endosc 2000; 14: 137-40.
- Blan- Louvry Le I, Coquerel A, Koning E, et al.: Operative stress response is reduced after laparosopic compared to open cholecystectomy. Dig Dis Sci 2000; 45: 1703-13.
- Targarona EM, Marco C, Balague C, et al.: How, when and why bile duct injury occurs. A comparison between open and laparoscopic cholecystectomy. Surg Endosc 1998; 12: 322-26.
- Lujan J A, Sanchez-Bueno F, Parilla P, et al.: Laparoscopic vs open cholecystectomy in patients aged 65 and older. Surg Laparosc Endosc 1998; 8: 208-10.
- Maxwell JG, Tyler BA, Maxwell BG, et al.: Laparoscopic cholecystectomy in octogenarians. Am Surg 1998; 64: 826-32.
- Kiviluoto T, Siren J, Luukkonen P, et al.: Randomised trial of laparoscopic versus open cholecystectomy for acute and gangrenous cholecystitis. Lancet 1998; 351: 321-25.[Crossref]
- Eldar S, Sabo E, Nash E, et al.: Laparoscopic cholecystectomy for the various types of gall-bladder inflammation. Surg Lapar Endosc 1998; 8: 200-07.
- Michalowski K, Borman PC, Krige JEJ, et al.: Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Brit J Surg 1998; 85: 904-06.[Crossref]
- So CB, Gibney RG, Scudamore ChH: Carcinoma of the gall-bladder: A risk associated with gall-bladder - preserving treatment for cholelithiasis. Radiology 1990; 174: 127-30.[PubMed]
- NIH Consensus Conference: Gallstones and laparoscopic cholecystectomy. JAMA 1993; 269: 1018-24.
- Shieh CJ, Dunn E, Standard JE: Primry carcinoma of the gall-bladder: a review of a 16-year experience at the Waterbury Hospital Health Center. Cancer 1981; 47: 996-1004.[Crossref]