Hyperkinetic Gallbladder Syndrome: A Retrospective Study

Gallbladder dysmotility issues present a significant challenge for clinicians and general surgeons. Adding a hepato-biliary scan to the diagnostic toolkit has greatly helped in understanding this condition, but how to proceed when dealing with hypermotility remains a real challenge, as predicting the outcome of a cholecystectomy, due to limited research, is difficult. Patients typically come to the office after an extended workup, with ultrasound and CT scans showing no abnormalities, normal liver chemistries, and an abnormal ejection fraction. At this point, the surgeon must clarify the plan and manage the patient's expectations. A retrospective review was conducted of all cases encountered by a single surgeon over a two-year period in patients who presented to the office with biliary-type symptoms, normal ultrasound results, and an elevated ejection fraction on hepatobiliary iminodiacetic acid (HIDA) scan. The problem was classified as Hyperkinetic Gallbladder Syndrome (HGS) and given a grade. The primary goal was to identify pathological abnormalities in the collected specimens and to relieve symptoms. Among all the laparoscopic cholecystectomies performed during this period, 32 cases with symptoms, negative ultrasounds, and elevated ejection fractions were identified. The male-to-female ratio was 1:4 (81% female patients), the median age range was 41-50 years, and 23 out of 32 patients had an ejection fraction above 80%. All removed specimens showed chronic cholecystitis in the histopathologic examination, and 30 out of 32 patients experienced symptom resolution at two to three weeks of follow-up. HGS is a legitimate condition, and when patients are properly evaluated and other causes for their symptoms are carefully ruled out, laparoscopic cholecystectomy can alleviate the symptoms. It is crucial to select patients appropriately and set clear expectations.