Challenging the Status Quo: Is Routine Histopathological Examination Necessary after Cholecystectomy?

Millicent HamadziripiKevin O'Hare, Paul Ridgway and Amy Gillis

Department of General Surgery & Department of Pathology, Tallaght University Hospital, Dublin, Ireland

^*Correspondance to: Millicent Hamadziripi 

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Abstract:

Background: Routine histopathological examination of gallbladders after cholecystectomy is standard practice in Ireland to detect incidental gallbladder carcinoma (GBC), a rare malignancy with poor prognosis. While comprehensive, this approach may not be cost-effective or sustainable in our low-incidence population. This study evaluates the feasibility of a selective approach of histopathology specimen processing based on well-described risk factors for GBC. Methods: A retrospective review was conducted of 935 gallbladder specimens submitted for histopathological examination over a five-year period after cholecystectomy at a single institution in Ireland. Clinical, imaging, and histology reports were analysed to identify cases of GBC which were subsequently reviewed in detail to identify clinical, radiological, and macroscopic predictors of malignancy. Results: Two patients (0.21%) with GBC were identified. Both patients had risk factors, including age >50 years, gallbladder polyps (>1 cm), and abnormal imaging findings. None of the patients had macroscopically abnormal features intraoperatively. These findings align with international evidence supporting the use of selective histopathological examination for cases with identifiable pre-operative risk factors. This approach can reduce the workload on histopathologists and costs without compromising patient outcomes. Conclusions: Given the low incidence of GBC in our population, adopting a selective approach to gallbladder histopathology processing presents a safe and cost-effective alternative to routine examination. Such a protocol could significantly reduce resource consumption and result in important cost savings to healthcare systems. As evidenced by the experiences in Sweden and the Netherlands, this approach can be implemented nationally while maintaining high diagnostic accuracy without overlooking cases of GBC.

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Cite the Article:

Hamadziripi M, O'Hare K, Ridgway P, Gillis A. Challenging the Status Quo: Is Routine Histopathological Examination Necessary after Cholecystectomy?. World J Surg Surgical Res. 2025; 8: 1606..