Does routine histopathological examination of gallbladder after simple cholecystectomy add additional value?

Abstract

Background: Cholecystectomy for gallbladder stone disease is a common surgical procedure. Gallbladder carcinoma is a rare malignancy with poor prognosis, which has been linked in some studies to pre-existing gall stone disease. The current practice is to send all gallbladder specimens after cholecystectomy for histopathological examination. This adds additional workload on the pathologists. Objective: To determine the necessity of routine histopathological examination of gallbladder specimens following simple cholecystectomy. Setting: Aseer Central Hospital, Abha, Saudi Arabia. Design: Retrospective cohort study. Method: Patients who had cholecystectomy for gallstone disease from April 2010 to March 2012 were included. Operative notes, histopathological reports and final diagnoses were reviewed. Result: The study included 803 patients who had simple cholecystectomy. Three of these patients were found to have gallbladder carcinoma, two females and one male. Dense adhesions were encountered in all malignant cases necessitating conversion from laparoscopic to open cholecystectomy in one case. Macroscopic examination revealed a thickened gallbladder in all three patients; two patients had mucosal papillary lesions and one patient had polypoidal projection and mucosal ulcerations. These findings were confirmed by the pathologist. On microscopic examination, two patients had adenocarcinoma while one patient had neuroendocrine tumor. Conclusion: Selective approach for sending gallbladder specimens after cholecystectomy seems justifiable with no compromise on detection of incidental gallbladder cancer. This approach would lead to a reduction of workload on the pathologist.