Usefulness of Hepatobiliary Scan with 99mTc- DISIDA in Laparoscopic Cholecystectomy by one Inexperienced Surgeon

Go, Gi Mun; Lee, Dae Sung

Abstract

PURPOSE: This study examined 50 cases of laparoscopic cholecystectomy performed by a single inexperienced surgeon to determine the usefulness of a hepatobiliary scan with 99mTc-DISIDA as the contributing factor related to the conversion to an open cholecystectomy.
METHODS
From July 2004 to June 2005, 34 patients, who underwent a laparoscopic cholecystectomy by an inexperienced surgeon, were evaluated. The effectiveness of a hepatobiliary scan with 99mTc-DISIDA as preoperative evaluation was also examined. The patients were divided into 3 groups according to the hepatobiliray scan findings: group A had normal findings, group B had decreased gallbladder contraction and group C had gallbladder nonvisualization. The patients' charts, age, gender, previous history of abdominal operation, preoperative laboratory data, preoperative ultrasound findings, pathologic findings, conversion rate to open cholecystectomy, surgical complication and hospital stay were reviewed.
RESULTS
The mean age was 52.7 years and the male-to- female ratio was 1 : 1.3. All 34 were diagnosed with a gallbladder stone in the preoperative ultrasound. The number of patients in group A, B, and C was 11, 15, and 8, respectively. The conversion rate was 0%, 0%, and 37%, respectively. The mean length of hospital stay was 5.5, 5.5, and 8 days in group A, B and C, respectively.
CONCLUSION
The conversion rate and hospital stay decreased in laparoscopic cholecystectomy as the surgical experience increased with the increasing number of cases. However, the conversion rate was still high in the inexperienced surgeon. A preoperative hepatobiliary scan with 99mTc- DISIDA allows inexperienced surgeons to predict the thickening of the gallbladder wall, inflammation and the anatomic conditions of the gallbladder, and discuss the high risk of conversion preoperatively.