Selective Histological Examination After Cholecystectomy: An Analysis of Current Daily Practice in The Netherlands

• DOI: 10.1007/s00268-019-05077-w
• Publication Date: 2019-07-08T17:02:30Z
• Authors: B. J. G. A. Corten; W. K. G. Leclercq; C. H. Dejong; R. M. H. Roumen; G. D. Slooter
• Keywords: Guideline; Cardiothoracic surgery; Vascular surgery; Gallbladder disease

AbstractBackgroundThe 2016 Dutch national guidelines on handling of a removed gallbladder for cholelithiasis proposes a selective histopathologic policy (Sel‐HP) rather than routine policy (Rout‐HP). The aim of this study was to determine the current implementation of the present guideline and the daily practice of Sel‐HP.MethodsSurgeons who were engaged in gallbladder surgery in the Netherlands and were involved in local hospitals’ gallbladder protocols completed a questionnaire study regarding gallbladder policy, between December 2017 and May 2018. Data were analyzed using standard statistics.ResultsA 100% response rate was obtained (n = 74). Approximately 64% of all gallbladders (n = 22,500) were examined microscopically. Sixty‐nine (93.2%) hospitals confirmed they were aware of the new guidelines, and 56 (75.7%) knew the guideline was adjusted in favor of Sel‐HP. Half of the hospitals (n = 35, 47.3%) had adopted a Sel‐HP, and 39 (52.7%) a Rout‐HP. Of the 39 hospitals who had a Rout‐HP, 36 were open to a transition to a Sel‐HP although some expressed the need for more evidence on safety or novel guidelines.ConclusionsThe current implementation of the 2016 Dutch guideline advising a selective microscopic analysis of removed gallbladders for gallstone disease is suboptimal. Evidence demonstrating safety and cost‐effectiveness of an on demand histopathological examination will aid in the implementation process.