Gallbladder agenesis: a systematic review of presentation, management, and outcomes

Introduction: Gallbladder agenesis (GA) is often misdiagnosed as a gallbladder pathology. This systematic review aimed to summarize the current evidence on epidemiology, clinical presentation, diagnostic approaches, and management strategies. Methods: PubMed/MEDLINE, Scopus, and Embase databases were comprehensively searched in English, French, and Spanish for GA cases published before November 2022. Two reviewers screened articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Data were analyzed to identify the clinical features, diagnostic approaches, management strategies, and associated factors. Results: A total of 9186 unique articles were screened, 125 of which met the inclusion criteria (151 cases in total). Most patients were female (66%), with a median age of 45 years. Most patients (73%) were diagnosed intraoperatively, and the most common presenting symptoms were right upper quadrant pain (66%), nausea (32%), or emesis (30%). Less than 15% of patients had elevated liver enzyme levels or leukocytosis. Ultrasonography was the primary imaging modality (81%). Most patients (79%) underwent operative management, with laparoscopy in 49.6% and exploratory laparotomy in 50.4%. Diagnosis by hepatobiliary iminodiacetic acid scan was associated with higher complications (odds ratio 8.53, 95% confidence interval 1.21–59.1, P = 0.026). There were more complications in the US cohort than in the non-US cohort (20% vs. 4.5%, P = 0.006). Conclusions: This systematic review showed that many patients with GA underwent unnecessary operative interventions with an associated increase in complications. Surgeons should be familiar with this diagnosis to minimize unnecessary interventions and reduce healthcare costs.