Limy bile and laparoscopic cholecystectomy

Objective to determine incidence of 'limy bile' in patients undergoing laparoscopic cholecystectomy; to analyze patient characteristics and preoperative imaging modalities in these patients and evaluate surgical treatment Patients and Methods : a retrospective analysis of 1800 laparoscopic cholecystectomies performed between March 1990 and March 1998 for symptomatic gallbladder disease. Results : Five patients with limy bile (0,27%) were identified. Four were female and one was male, age varied from 42 to 66. Most patients were symptomatic longtime before presentation. Ultrasound was not able to differentiate between normal gallstones or sludge. In three patients the diagnosis was made before operation, in one patient it was an incidental finding. Surgery in these patients is not more difficult than in any other patient. Conclusion : Limy bile is a rare finding (0,27% in 1800 cholecystectomies). Plain abdominal X-rays mostly suggest the presence of calcium carbonate precipitate in the gallbladder, but ultrasound cannot differentiate between cholelithiasis and limy bile. Laparoscopic resection can be performed without problems in most patients. Preoperative diagnosis of this rare entity is not essential, as it does not alter treatment.