Method for adequate macroscopic gallbladder examination after cholecystectomy

Acta chirurgica Belgica, vol. 120, pp. 442–450

Abstract

Background and aims There is no clear guideline nor protocol for macroscopic examination of the gallbladder, leaving surgeons extemporaneous in regard of gallbladder examination in selective histopathologic policy. The purpose of this article is to describe a surgical approach for adequate macroscopic inspection of the gallbladder.Materials and methods The described practical method was developed in collaboration between surgeons and pathologists. This method was introduced in 2011 and implemented in 2012. We retrospectively reviewed the number of cholecystectomies and number of histopathologic examinations between 2006 and 2017, using our own patient database. We used the Netherlands Cancer Registry (NCR) to examine the incidence of gallbladder cancer patients before and after implementation of the selective policy in our hospital. In addition to the method, we depict several frequent macroscopic abnormalities in order to provide some examples for surgical colleagues.Results Since implementation of the selective policy, 2271 surgical macroscopic gallbladder examinations were performed. As a result, we observed a significant decrease from 83% in 2012 to 38% in 2017, in histopathologic examination of the gallbladder following cholecystectomy. We observed a stable trend of gallbladder carcinoma in the same period (0.17%, n = 4 during 2006–2011 and 0.26%, n = 6 during 2012–2017).Conclusion A simple, valid and easy method is described for future macroscopic analysis by the surgeon following a cholecystectomy.

Authors 6

1. B.J.G.A. Corten

   Maastricht University Medical Centre · Máxima Medisch Centrum

   Affiliation as printed

   Department of Surgery, Maastricht University Medical Centre

   Department of Surgery, Máxima Medical Center

   Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

2. Wouter K. G. Leclercq

   Máxima Medisch Centrum

   Affiliation as printed

   Department of Surgery, Máxima Medical Center

   Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands

3. Peter H. van Zwam

   PAMM

   Affiliation as printed

   Department of Pathology, PAMM laboratory for pathology and medical microbiology

   Department of Pathology, PAMM laboratory for pathology and medical microbiology, Eindhoven, The Netherlands

4. Rudi M. H. Roumen

   Máxima Medisch Centrum

   Affiliation as printed

   Department of Surgery, Máxima Medical Center

   Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands

5. Cees H. C. Dejong Aachen Department of General, Visceral and Transplantation Surgery

   Maastricht University Medical Centre · Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen

   Department of Surgery, Maastricht University Medical Centre

   Department of General, Visceral and Transplantation Surgery, RWTH University Hospital Aachen, Aachen, Germany

   Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands

6. Gerrit Dirk Slooter corresponding

   Máxima Medisch Centrum

   Affiliation as printed

   Department of Surgery, Máxima Medical Center

   Department of Surgery, Máxima Medical Center, Veldhoven, The Netherlands