The Value of Routine Histopathology After Laparoscopic Cholecystectomy: A Single-Centre Retrospective Analysis

TL;DR

This study finds that routine histopathology after cholecystectomy rarely reveals significant issues and may not be worth the cost.

Contribution

The study provides evidence against routine histopathology for all cholecystectomy specimens due to low clinical benefit.

Findings

Only 0.58% of specimens showed low-grade dysplasia with no further intervention needed.

99.4% of cases confirmed benign inflammatory disease.

Routine histopathology is costly with minimal patient benefit.

Abstract

Introduction

Laparoscopic cholecystectomy is among the most common general surgical procedures globally. While many centers routinely send all gallbladder specimens for histopathological examination, the clinical and cost-effectiveness of this practice is debated. This study evaluates the utility of a routine approach compared to a selective one.

Methods

We conducted a retrospective observational study of 171 patients (n=171) who underwent elective, expedited, or urgent laparoscopic cholecystectomy at Warwick Hospital between 1 July 2023 and 30 January 2024. Data were extracted from the theatre management system (ORMIS) and electronic patient records (E-volve).

Results

The cohort comprised 118 females (69%) and 53 males (31%), with a mean age of 53.1 years (±14.6). Most procedures were elective (73.7%, n=126), followed by expedited (14.6%, n=25) and urgent (11.7%, n=20). Histopathological analysis identified a single case (0.58%, n=1) of low-grade dysplasia with clear margins, which required no further intervention. The vast majority of specimens (99.4%, n=170) confirmed benign inflammatory disease.

Conclusion

The incidence of unexpected, clinically significant histopathological findings is exceptionally low. Subjecting all cholecystectomy specimens to routine histopathology imposes a substantial financial burden on the healthcare system with minimal patient benefit. A selective policy, guided by intraoperative macroscopic appearance and patient risk factors, represents a more rational and cost-effective strategy.

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