TTP7.05 Is Routine Histopathological Examination of All Cholecystectomy Specimens Necessary?

Abstract Aim Laparoscopic cholecystectomy (LC) is one of the most frequently performed general surgical procedures. In the United Kingdom, gallbladder specimens are routinely submitted for histopathological analysis to detect occult pathologies, such as carcinoma in situ and early-stage carcinomas. This study aims to assess the results of routine histopathological examination of LC specimens. Methods This was a multicentre retrospective observational study of all consecutive adult patients undergoing elective and emergency cholecystectomy at three hospitals between August 2023 and July 2024. Data collected included patient demographics, operative details, and histopathology results. All gallbladder specimens were sent for histopathology analysis, irrespective of their gross appearance as per the hospital policy. Results 564 patients were identified, median age was 53 years and 404 (71.6%) were female. Of these, histopathology results were available for 554 patients. 34 (6%) had sub-total cholecystectomy. Histopathological result were: 416 (75.1%) chronic cholecystitis, 73 (13.2%) acute on chronic cholecystitis, 18 (3.2%) acute cholecystitis, 14 (2.5%) gangrenous acute cholecystitis, 13 (2.3%) unremarkable gallbladder, 13 (2.3%) xanthogranulomatous cholecystitis, 6 (1.1%) low grade dysplasia and one (0.25) adenomyomatous hyperplasia. There were no gallbladder carcinoma in this cohort. Conclusion Chronic calculus cholecystitis was the most frequent histopathological finding, followed by acute on chronic cholecystitis and gangrenous acute cholecystitis. Low grade dysplasia was identified in 1.1% of patients. The result of this study support a more selective approach to histopathological examination in regions with a very low incidence of gallbladder carcinoma. This strategy is more cost-effective, reduces pathologists' workload, and does not compromise patient outcomes.