Abstract
Surgical treatment of 45 patients presenting with extremely thick and contracted gallbladder of less than 5 cm in length has been reviewed. They corresponded to 4.8% of 938 patients with benign biliary diseases operated on during the last 12 years in our hospital. Though 44 patients had stones in the biliary trees, coexistence of background lesions was noted, that is, internal biliary fistula in 15, confluence stones in 5, and endoscopic papillotomy in 10 cases. Preoperative detection of contracted gallbladder was capable in 86% by computerized tomography, while it was not easy to visualize by ultrasound, and 61% of the cases were therefore estimated as such by acoustic shadow and/or strong echo.
Surgical treatment principally consisted of cholecystectomy with or without T tube drainage. Standard cholecystectomy with serosal dissection, however, was possible in only 5 cases. Partial resection of the gallbladder with remnant mucosal destruction was the choice of operation in 10 difficult cases. Bile duct injury as the main complication in the operation was repaired by hepaticojejunostomy in one case. Association of cancer of the gallbladder was noted in 2 cases (4.4%).
We conclude from this study that operation of contracted gallbladder should intend as much mucosal removal as possible within the limits of safety. Since preoperative evaluation for coexistence of cancer is almost impossible, intraoperative pathological diagnosis of the specimen is indispensable.
