296 Real-World Outcomes of Laparoscopic Cholecystectomy for Biliary Dyskinesia: A Multicentre Cohort Study

Abstract Aim Biliary dyskinesia (BD) presents with biliary-type pain despite normal imaging and liver tests, typically diagnosed by low gallbladder ejection fraction on HIDA scan. Laparoscopic cholecystectomy (LC) is the only established treatment, though its benefit remains debated due to variable symptom resolution. This multicentre study assessed outcomes following LC for BD, focusing on symptom resolution. Method A retrospective cohort study was conducted on patients with BD (ejection fraction ≤35% on HIDA) from January 2011 to December 2023 across three acute hospitals. Patients with gallstones, microlithiasis, or postoperative bile leak were excluded. Records were reviewed for demographics, symptom duration, BMI, LFTs, imaging, endoscopy, and histopathology. Rome IV criteria confirmed biliary-type symptoms. Minimum follow-up was two years. Results Of 348 HIDA scans, 49 (14.1%) met BD criteria. Median age was 42 (IQR 33–55), BMI 26.7 (IQR 23.9–30.3); 79.6% were female. Median symptom duration was 18 months. Endoscopy was performed in 46 (93.9%) patients, with gastritis/duodenitis noted in 19 (41.3%). LC was performed in 26 (53.1%); 2 (4.1%) await surgery, 5 (10.2%) were lost to follow-up, and 16 (32.7%) were discharged without surgery. Histology showed chronic cholecystitis (73.1%), cholesterosis (11.5%), and normal findings (15.4%). At 12 months, 38.5% reported persistent pain, often with comorbidities such as fibromyalgia, IBS, or psychiatric illness. Conclusions BD is a debilitating but non-progressive condition. LC provides meaningful symptom relief in well-selected patients and should be considered after careful assessment. A multidisciplinary approach and thorough counselling are essential to manage expectations and address overlapping functional comorbidities.