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Suhal S. Mahid, MD, PhD; Nadim S. Jafri, MD, MSc; Baylor C. Brangers; Kyle S. Minor, BA; Carlton A. Hornung, PhD, MPH; Susan Galandiuk, MD

Arch Surg. 2009;144(2):180-187.

Objective  To study the clinical results of surgical management in patients with right upper quadrant pain, a positive hepatobiliary iminodiacetic acid (HIDA) scan result, and no gallstones.

Data Sources  Health care databases and gray literature.

Study Selection  Each article was scrutinized to determine whether it met inclusion criteria. Only abstracts, full articles, and gray literature that passed the detailed screening procedure were included. Case reports, letters, comments, reviews, and abstracts with insufficient details to meet inclusion criteria were excluded. Gallbladder ejection fraction assessed by means other than cholecystokinin HIDA scan were also excluded.

Data Extraction  Three reviewers independently abstracted the following data from each article: first author, year of publication, journal, type of study, location of study population, institution where the study was conducted, symptoms recorded, imaging modality used to establish the absence of gallstones, HIDA scan ejection fraction, number of cases and controls, number of males and females in each group, method of follow-up, and number of cases lost to follow-up.

Data Synthesis  Ten studies met inclusion criteria (N = 615). Follow-up ranged from 3 to 64 months. Surgical treatment was 15-fold more likely than medical treatment to result in symptom improvement, with 4% of patients reporting no symptom improvement with surgery. Sensitivity analysis in patients with complete symptom relief following surgery revealed an 8-fold greater odds difference than those treated medically (indicating variation in study reporting).

Conclusions  Patients without gallstones who have right upper quadrant pain and a positive HIDA scan result are more likely to experience symptom relief following cholecystectomy than those treated medically. There is, however, wide variability in data reporting, particularly with respect to symptom relief and duration of follow-up. Cholecystectomy is indicated in symptomatic patients without gallstones who have a low–ejection fraction HIDA scan.

Author Affiliations: Price Institute of Surgical Research and the Section of Colorectal Surgery, Department of Surgery (Drs Mahid and Galandiuk and Messrs Brangers and Minor), Division of Internal Medicine, Department of Medicine (Dr Jafri), and Department of Epidemiology and Clinical Investigation Science (Dr Hornung), University of Louisville School of Medicine, Louisville, Kentucky.

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