Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis

1 Federal University of Paraíba (UFPB), Medical Sciences Center, Medicine Course, João Pessoa, Paraíba, Brasil. 2 Federal University of Paraíba (UFPB), Medical Sciences Center, Medicine Course, Surgery Department, João Pessoa, Paraíba, Brasil. Holanda Gallbladder histological alterations in patients undergoing cholecystectomy for cholelithiasis. 2 Rev Col Bras Cir 46(6):e20192279 We excluded from the sample the requests in which the hypothesis of gallbladder neoplasia was raised in the preoperative period. The patients were operated by several surgeons of the same team. After removal of the gallbladder from the abdominal cavity, a macroscopic examination was performed by the surgeon and the specimen was then referred for anatomopathological examination in a 10% formaldehyde solution. In the Pathological Anatomy Service, the specimen was again submitted to macroscopic evaluation, and the suspected areas were properly treated and mounted on glass slides for microscopic analysis. In the absence of any suspicious areas, the specimen was subjected to routine examination, in which a random sample of the fundus, body and vesicular neck were analyzed. The following histological changes were studied: chronic cholecystitis, acute cholecystitis, scleroatrophy, gangrene, abscess, xantogranulomatous cholecystitis, fibrosis, cholesterolosis, pyloric metaplasia, intestinal metaplasia, dysplasia and cancer. We divided the patients into two groups as to age: under 60 years and 60 years or more. We classified the thickness of the gallbladder wall as thin (<0.3cm) or thick (≥0.3cm). We performed descriptive analysis of the data and then we used the Pearson’s chi-square test (x2) to assess associations between histological alterations and gender, age range and gallbladder wall thickness. In cases where there was no possibility of applying the chi-square test, we replaced it by the Fisher's exact test. In all tests, the null hypothesis rejection level was set at 5%. This research was approved by the Ethics in Research Committee of the Medical Sciences Center of the Federal University of Paraíba, with CAAE protocol number 01759418.5. 0000.806 9. RESULTS Of the 1,278 reports under analysis, 992 (77.6%) were from females and 286 (22.4%), from males. The mean age was 43±17.8 years, 43±17 years for women and 44±20.6 years for men; 1,051 (82.2%) patients were under 60 years old and 227 (17.8%), 60 years or older. Of the 1,278 patients diagnosed with cholelithiasis, 1,261 (98.7%) were symptomatic before surgery, while only 17 (1.32%) had no symptoms. Table 1 shows the frequency of the histological changes studied, regardless of the association between two or more diagnoses in the same patient, which occurred in some cases. The most common anatomopathological finding was chronic cholecystitis, which was present in 1,251 patients (97.8%), followed by cholesterolosis in 131 (10.2%). Gallbladder cancer was found in only six patients (0.5%). Figure 1 shows the histological aspects observed in some of the gallbladder histological changes. Table 1. Frequency distribution of histological changes. Histological change no % Chronic cholecystitis 1,252 97.8 Cholesterolosis 131 10.2 Acute cholecystitis 36 2.8 Xantogranulomatous cholecystitis 23 1.8