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Assessing Disease Severity in Patients With Cholelithiasis: The HIDA Way:  Comment on “Hepatobiliary Scan for Assessing Disease Severity in Patients With Cholelithiasis”

John J. Brems, MD
Arch Surg. 2011;146(2):174. doi:10.1001/archsurg.2011.3.
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Cho and colleagues advocate the use of hepatobiliary imaging to predict the severity of cholecystitis and the difficulty of performing a laparoscopic cholecystectomy. In a large retrospective study that includes more than 1000 patients who underwent laparoscopic cholecystectomy for benign gallbladder disease, they found that a gallbladder ejection fraction (GBEF) less than 30.0% is a predictor of the difficulty of the operation. Therefore, they recommend that a hepatobiliary scan (HIDA) be performed before a cholecystectomy to predict the difficulty of the operation and to be able to plan accordingly. Their data may be skewed because they included, in the group of patients who had an ejection fraction of 30.0% or greater, patients with gallbladder polyps, a group that had the easiest operations and the fewest complications. In addition, they do not mention the number of patients who had a hepatobiliary scan and did not undergo a laparoscopic cholecystectomy.

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