Method for adequate macroscopic gallbladder examination after cholecystectomy

Figures & data

Figure 1. (a–f) Sequential steps of macroscopic examination of the gallbladder by the surgeon. Full video is available in the Supplementary appendix.

Table 1. Reasons for additional histopathologic examination.

Preoperative suspicion of gallbladder cancer

Macroscopic abnormalities of the gallbladder found during surgery or during macroscopic inspection.

Focal calcifications or porcelain gallbladder

Acute cholecystitis^a

Conversion to open laparotomy or subdiafragmal incision^a

Gallbladder polyp

Primary Sclerosing Cholangitis

Mirizzi syndrome

Inability or doubt regarding adequate macroscopic examination by the surgeon

^a Relative indications.

Figure 2. (a, b) Macroscopic images of a normal appearance of the gallbladder mucosa. Please notice the smooth and glistening serosa and folded mucosa. The numerous spots are cholesterolosis, which is accumulation of lipoma filled macrophages in the mucosa. (c, d) Macroscopic image of acute cholecystitis gallbladder.

Figure 3. (a) Macroscopic image of a 1.8 cm large adenomyoma of the gallbladder at the hepatic side after 24 h of formaldehyde fixation. (b, c) Macroscopic image of a hyperplastic polyp is indicated with arrow (◄). (d, e) Macroscopic image of a multiple cholesterol gallbladder polyps indicated with arrows (◄).

Figure 4. (a, b) Macroscopic image of a porcelain gallbladder. (c) Macroscopic image of gallbladder containing T2 GBC in the fundus of the gallbladder. Mucosal irregularity containing GBC is indicated with arrow (◄). (d, e) Macroscopic image of gallbladder containing T3 GBC in the fundus of the gallbladder (◄) and liver metastasis (◄◄). (f) Macroscopic image of gallbladder with liver resection (◄). (g) Macroscopic image of intracholecystic papillary neoplasm with highgrade dysplasia (◄◄).

Table 2. Number of cholecystectomies per year and the number of histopathologic gallbladder specimens sent to department of pathology.

The small discrepancy in cholecystectomies coded as performed and ultimate histopathologic examinations of specimens in the years 2006–2011 is not a result of a selective policy, but the result of the preoperative abandoning of cholecystectomy due to too severe cholecystitis. Numbers are displayed on primary axis (left).