# 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.

## Key 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.