Digestive Diseases and Sciences

, Volume 59, Issue 12, pp 2850–2863 | Cite as

Cholecystectomy for Biliary Dyskinesia: How Did We Get There?

  • Klaus Bielefeldt
  • Shreyas Saligram
  • Susan L. Zickmund
  • Anwar Dudekula
  • Mojtaba Olyaee
  • Dhiraj Yadav



The focus of biliary dyskinesia (BD) shifted within the last 30 years, moving from symptoms after cholecystectomy (CCY) to symptoms with morphological normal gallbladder, but low gallbladder ejection fraction.


We searched the pubmed database to systematically review studies focusing on the diagnosis and treatment of gallbladder dysfunction.


Impaired gallbladder contraction can be found in about 20 % of healthy controls and an even higher number of patients with various other disorders. Surgery for BD increased after introduction of laparoscopic CCY, with BD now accounting for >20 % of CCY in adults and up to 60 % in pediatric patients. The majority of cases reported were operated in the USA, which differs from surgical series for cholelithiasis. Postoperative outcomes do not differ between groups with abnormal or normal gallbladder function.


Functional gallbladder testing should not be seen as an indicator of relevant biliary tract disease or prognostic marker to identify patients who may benefit from operative intervention. Instead biliary dyskinesia should be considered as a part of a spectrum of functional disorders, which are generally managed conservatively. Small proof of concept studies have demonstrated effects of medical therapy on biliary dysfunction and should thus be never tested in appropriately designed trials.


Biliary diseases Gallbladder ejection fraction Cholecystectomy Biliary dyskinesia Abdominal pain Functional gastrointestinal disorders 


Conflict of interest



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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Klaus Bielefeldt
    • 1
  • Shreyas Saligram
    • 2
    • 4
  • Susan L. Zickmund
    • 2
    • 3
  • Anwar Dudekula
    • 2
  • Mojtaba Olyaee
    • 4
  • Dhiraj Yadav
    • 1
  1. 1.Divisions of GastroenterologyUniversity of Pittsburgh Medical CenterPittsburghUSA
  2. 2.General Internal MedicineUniversity of Pittsburgh Medical CenterPittsburghUSA
  3. 3.Center of Health Equity Research and PracticeVeteran Administration Health System PittsburghPittsburghUSA
  4. 4.Divisions of GastroenterologyKansas University of Medical SciencesLawrenceUSA

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