110 Cystic Duct Dysplasia: A Silent Dilemma in Gallbladder Surgery

Abstract Background Incidental dysplasia of the gallbladder (GB) is identified in approximately 1–3% of cholecystectomy cases. Despite its potential link to malignancy, especially when involving the cystic duct, there is limited evidence and no standardized management guidelines. This study reviews current management practices and highlights the need for clearer protocols. Aim To evaluate the management and outcomes of incidental gallbladder dysplasia identified post-cholecystectomy. Method A retrospective review of gallbladder histology from 2017 to 2021 included all cases with dysplasia, excluding those with preoperative hepatobiliary malignancy or polyps. Data included demographics, surgical details, histology, and follow-up. Results Out of 41 cases of gallbladder dysplasia, 95% were female with a mean age of 53.6 years. Low-grade dysplasia accounted for 92.6% of cases, with multifocal involvement in 36.8%. Metaplasia was present in 63.4% of cases. Cystic duct margins were free in 87.8%, involved in 4.8%, and unspecified in 7.3%. No further surgical intervention was performed, and no patients developed hepatobiliary malignancy during a mean follow-up of 48 months. Conclusions Incidental low-grade dysplasia in the cystic duct following routine cholecystectomy presents a clinical challenge due to the absence of standardized management guidelines. While no progression to malignancy was observed in this cohort over a mean follow-up of four years, the variability in histological features and margin involvement underscores the need for a more structured approach. Establishing evidence-based protocols through multicenter studies is required to guide surveillance and treatment strategies.