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Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center

Year 2017, Volume: 9 Issue: 3, 243 - 249, 22.09.2017
https://doi.org/10.18521/ktd.325651

Abstract




Objective: it was aimed to evaluate the results of routine histopathological
examination after cholecystectomy and to investigate the necessity of routine
histopathologic examination after cholecystectomy.




 Methods: The study was designed retrospectively. 1366 patients who
underwent laparoscopic and open cholecystectomy at our center with
pre-diagnosis of benign gallbladder disease between November 2011 and May
2017were included in the study.
Patients' demographic data, pathologic results, macroscopic
appearance of the specimen, and cancer staging were recorded. The distribution
and frequency of pathologic diagnoses and the prevalence of incidental 
gallbladder cancer (GBC) were
evaluated. Pathologic findings were compared in terms of age groups and gender
relations.




Results: The
number of patients included in the study was 1,366. 1,303 patients (95%) were
diagnosed with chronic cholecystitis, 39 (3%) with acute cholecystitis, 7
(0.5%) with  GBC, and 17 (1.5%) with other diagnoses of the
patients.
Statistical
significance was found between the groups in terms of the mean age (p =
0.0002).
Comparisons
between groups in terms of cholesterolysis were statistically significant (p =
0.0003).
There was a
significant relationship between mucosa atrophy and gender (p = 0.001).




Discussion: The
histopathological spectrum of gallbladder is quite extensive. Incidental GBC
may not be detected by preoperative imaging methods. Incidental GBC are usually
asymptomatic. T2, T3 and T4 GBC were also encountered in our study. All of
these patients need additional operations. In the absence of routine
histopathologic examination, metastatic advanced GBC may be encountered because
no treatment plans could make. Thus, we do recommend routine histopathological
examination.




References

  • 1. Cancer Statistics Registrations, England (Series MB1), No. 43, 2012. Office for National Statistics. http://www.ons.gov.uk/ons/rel/vsob1/cancer-statisticsregistrations–england–series-mb1-/no–43–2012/ (cited June 2015). 2. Lobo L, Prasad K, Satoskar RR. Carcinoma of the gall bladder: a prospective study in a tertiary hospital of Bombay, India. J Clin Diagn Res 2012; 6(4):692–695. 3. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 2006; 118: 1,591–1,602. 4. Darmas B, Mahmud S, Abbas A, et al. Is there justification for the routine histological examination of straightforward cholecystectomy specimen? Ann R Coll Surg Engl 2007; 89: 238–241. 5. Hueman MT, Vollmer CM Jr, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009;16(8):2101-15. 6. Taylor HW, Huang JK. ‘Routine’ pathological examination of the gallbladder is a futile exercise. Br J Surg 1998; 85: 208. 7. Jetley S, Rana S, Khan S, et al. Incidental gall bladder carcinoma in laparoscopic cholecystectomy: a report of 6 cases and a review of the literature. J Clin Diagn Res 2013; 7: 85–88. 8. Kalita D, Pant L, Singh S, et al. Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy – a study of 4,115 cholecystectomy specimens. Asian Pac J Cancer Prev 2013; 14: 3.315–18. 9. Agarwal AK, Kalayarasan R, Singh S, et al. All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB (Oxford). 2012;14(4):269-73. 10. D. Fuks, J.M. Regimbeau, Y.P. Le Treut, et al. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg. 2011;35(8):1887-97. 11. Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act? BMC Surg. 2013;13:26. 12. Basak F, Hasbahceci M, Canbak T, et al. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Engl. 2016;98(4):280-3. 13. Emmett CD, Barrett P, Gilliam AD, et al. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl. 2015;97(7):526-9. 14. Mittal R, Jesudason MR, Nayak S. Selective histopathology in cholecystectomy for gallstone disease. Indian J Gastroenterol 2010; 29: 26–30. 15. Ramraje SN, Pawar VI. Routine histopathologic examination of two common surgical specimens-appendix and gallbladder: is it a waste of expertise and hospital resources? Indian J Surg. 2014;76(2):127-30. 16. Lohsiriwat V, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg 2009; 33: 2.189–93. 17. Pai SA, Bhat MG. Selective histopathology of gall bladders is unscientific and dangerous. Surgeon 2004; 2: 241. 18. Chin KF, Mohammad AA, Khoo YY, et al. The impact of routine histopathological examination on cholecystectomy specimens from an Asian demographic. Ann R Coll Surg Engl. 2012;94(3):165-9. 19. Channa NA, Soomro AM, Ghangro AB. Cholecystectomy is becoming an increasingly common operation in Hyderabad and adjoining areas. Rawal Med J 2007, 32(2):128–130. 20. Park JW, Kim KH, Kim SJ, et al. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc. 2017 Jun 7. doi: 10.1007/s00464-017-5604-z. 21. Rao RV, Kumar A, Sikora SS, et al. Xanthogranulomatous cholecystitis: differentiation from associated gallbladder carcinoma. Trop Gastroenterol 2005;26:31–3. 22. Sánchez-Pobre P, López-Ríos Moreno F, Colina F, et al. Eosinophilic cholecystitis: an infrequent cause of cholecystectomy. Gastroenterol Hepatol. 1997;20(1):21-3. 23. Matos AS, Baptista HN, Pinheiro C, et al. Gallbladder polyps: how should they be treated and when? Rev Assoc Med Bras (1992). 2010;56(3):318-21. 24. Cha BH, Hwang JH, Lee SH, et al. Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 2011; 17: 2216-22. 25. Park KW, Kim SH, Choi SH, et al. Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multidetector row computed tomography. J Comput Assist Tomogr 2010; 34: 135-9. 26. Andrén-Sandberg A. Diagnosis and Management of Gallbladder Polyps. N Am J Med Sci 2012; 4: 203-11. 27. SAGES Guideline Committee. SAGES guidelines for the clinical application of laparoscopic tract surgery, section H – gallbladder polyps. January 2010. Available at http://www.sages.org/publications/id/06/. 28. Dairi S, Demeusy A, Sill AM, et al. Implications of gallbladder cholesterolosis and cholesterol polyps? J Surg Res. 2016;200 (2):467-72. 29. T. Ozgur, S. Toprak, A. Koyuncuer, M. et al. Do histopathological findings improve by increasing the sample size in chole-cystectomies. World J Surg Oncol. 2013;11:245. 30. Parrilla Paricio P, Garcia Olmo D, Pellicer Franco E, et al. Gallbladder cholesterolosis: an aetiological factor in acute pancreatitis of uncertain origin. Br J Surg 1990; 77:735. 31. Khairy GA, Guraya SY, Murshid KR. Cholesterolosis. Incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy. Saudi Med J 2004;25:1226. 32. Yaylak F, Deger A, Ucar BI, et al. Cholesterolosis in routine histopathological examination after cholecystectomy: what should a surgeon behold in the reports? Int J Surg. 2014;12(11):1187-91 33. Roa I, de Aretxabala X, Ibacache G, et al. Association between cholesterolosis and gallbladder cancer. Rev Med Chil. 2010;138(7):804-8. 34. Wang X, Magkos F, Mittendorfer B. Sex differences in lipid and lipoprotein metabolism: it's not just about sex hormones. J Clin Endocrinol Metab. 2011;96(4):885-93. 35. Hassan EH, Gerges SS, El-Atrebi KA, et al. pylori infection in gall bladder cancer: clinicopathological study. Tumour Biol. 2015;36(9):7093-8. 36. Dix FP, Bruce IA, Krypcyzk A, et al. A selective approach to histopathology of the gallbladder is justifiable. Surgeon 2003; 1: 233–235. 37. Grobmyer SR, Lieberman MD, Daly JM. Gallbladder cancer in the twentieth century: single institution’s experience. World J Surg 2004; 28: 47–49. 38. Solaini L, Sharma A, Watt J et al. Predictive factors for incidental gallbladder dysplasia and carcinoma. J Surg Res 2014; 189: 17–21. 39. Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg 2000; 7: 556–567. 40. Hart J, Modan B, Shani M. Cholelithiasis in the aetiology of gallbladder neoplasms. Lancet 1971; 1: 1,151–1,153. 41. Sujata J, Rana S, Sabina K et al. Incidental gall bladder carcinoma in laparoscopic cholecystectomy: a report of 6 cases and a review of the literature. J Clin Diagn Res 2013; 7: 85–88. 42. Deng YL, Xiong XZ, Zhou Y et al. Selective histology of cholecystectomy specimens–is it justified? J Surg Res 2015; 193: 196–201. 43. Swank HA, Mulder IM, Hop WC, et al. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review. Surg Endosc 2013; 27: 4,439–4,448. 44. Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 1996;224: 639–646. 45. Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg. 2009;33(12):2657-63.

Kolesistektomi sonrası rutin histopatlojik safra kesesi incelemesi gerekli mi?: Tek merkezdeki 1366 kolesistektomi spesmeninin sonuçlarının değerlendirilmesi

Year 2017, Volume: 9 Issue: 3, 243 - 249, 22.09.2017
https://doi.org/10.18521/ktd.325651

Abstract

Amaç: Kolesistektomi
sonrası rutin olarak yapılan histopatolojik inceleme sonuçlarının
değerlendirilmesi, kolesistektomiler sonrası rutin histopatolojik incelemenin
gerekliliğini araştırmak amaçlanmıştır.

Gereç ve Yöntem: Çalışma
retrospektif olarak dizayn edilmiştir. Bening safra kesesi hastalığı ön tanısı
ile Kasım 2011- Mayıs 2017 yılları arasında merkezimizde Laparaskopik ve açık
kolesistektomi uygulanan 1366 hasta çalışmaya dahil edildi.
Hastaların
demografik verileri, patoloji sonuçları, spesmenin makroskopik görünümü, kanser
evrelemesi kayıt edildi.
Patolojik tanıların dağılımı ve sıklığı,
incidental safra kesesi kanseri prevalansı değerlendirildi.

Bulgular: Çalışmaya
dahil edilen hasta sayısı 1366 idi. Hastaların 1303 (%95)’ü kronik kolesistit,
39 (%3)’u akut kolesistit, 7 (%0.5)’i safra kesesi kanseri, 17 (%1.5) hastada
diğer tanılar tespit edildi.
Gruplar arasında yaş ortalaması
açısından istatistiksel anlamlılık saptandı (p=0.0002).
Kolesterolizis
açısından gruplar arasında yapılan karşılaştırmalarda istatistiksel olarak
anlamlılık bulundu (p=0.0003).
Mukoza atrofisi ile cinsiyet
arasında anlamlı ilişki tespit edildi (p=0.001).







Tartışma: Safra
kesesi spesmenlerinin histopatolojik incelenmesinde en sık görülen tanı kronik
kolesistitdir. Ancak kolesistektomi sonrası, safra kesesinin histopatolojik
spekturumu oldukça geniştir. İncidental safra kesesi tümörleri preoperative
görüntüleme yöntemleri ile tespit edilemeyebilir. İncidental safra kesesi
tümörleri genellikle asemptomtomatik seyretmektedir. Çalışmamızda T2, T3 ve T4
safra kesesi tümörlerine de rastlanılmıştır. Bu hastaların tümüne ek girişimler
gerekmiştir. Rutin histopatolojik inceleme yokluğunda, tedavi planı
yapılamadığından metastatic ileri evre safra kesesi tümörleriyle
karşılaşılabilir. Bu nedenle rutin histopatolojik incelemenin yapılmasını
önermekteyiz.

References

  • 1. Cancer Statistics Registrations, England (Series MB1), No. 43, 2012. Office for National Statistics. http://www.ons.gov.uk/ons/rel/vsob1/cancer-statisticsregistrations–england–series-mb1-/no–43–2012/ (cited June 2015). 2. Lobo L, Prasad K, Satoskar RR. Carcinoma of the gall bladder: a prospective study in a tertiary hospital of Bombay, India. J Clin Diagn Res 2012; 6(4):692–695. 3. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer worldwide: geographical distribution and risk factors. Int J Cancer 2006; 118: 1,591–1,602. 4. Darmas B, Mahmud S, Abbas A, et al. Is there justification for the routine histological examination of straightforward cholecystectomy specimen? Ann R Coll Surg Engl 2007; 89: 238–241. 5. Hueman MT, Vollmer CM Jr, Pawlik TM. Evolving treatment strategies for gallbladder cancer. Ann Surg Oncol. 2009;16(8):2101-15. 6. Taylor HW, Huang JK. ‘Routine’ pathological examination of the gallbladder is a futile exercise. Br J Surg 1998; 85: 208. 7. Jetley S, Rana S, Khan S, et al. Incidental gall bladder carcinoma in laparoscopic cholecystectomy: a report of 6 cases and a review of the literature. J Clin Diagn Res 2013; 7: 85–88. 8. Kalita D, Pant L, Singh S, et al. Impact of routine histopathological examination of gall bladder specimens on early detection of malignancy – a study of 4,115 cholecystectomy specimens. Asian Pac J Cancer Prev 2013; 14: 3.315–18. 9. Agarwal AK, Kalayarasan R, Singh S, et al. All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB (Oxford). 2012;14(4):269-73. 10. D. Fuks, J.M. Regimbeau, Y.P. Le Treut, et al. Incidental gallbladder cancer by the AFC-GBC-2009 Study Group. World J Surg. 2011;35(8):1887-97. 11. Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act? BMC Surg. 2013;13:26. 12. Basak F, Hasbahceci M, Canbak T, et al. Incidental findings during routine pathological evaluation of gallbladder specimens: review of 1,747 elective laparoscopic cholecystectomy cases. Ann R Coll Surg Engl. 2016;98(4):280-3. 13. Emmett CD, Barrett P, Gilliam AD, et al. Routine versus selective histological examination after cholecystectomy to exclude incidental gallbladder carcinoma. Ann R Coll Surg Engl. 2015;97(7):526-9. 14. Mittal R, Jesudason MR, Nayak S. Selective histopathology in cholecystectomy for gallstone disease. Indian J Gastroenterol 2010; 29: 26–30. 15. Ramraje SN, Pawar VI. Routine histopathologic examination of two common surgical specimens-appendix and gallbladder: is it a waste of expertise and hospital resources? Indian J Surg. 2014;76(2):127-30. 16. Lohsiriwat V, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg 2009; 33: 2.189–93. 17. Pai SA, Bhat MG. Selective histopathology of gall bladders is unscientific and dangerous. Surgeon 2004; 2: 241. 18. Chin KF, Mohammad AA, Khoo YY, et al. The impact of routine histopathological examination on cholecystectomy specimens from an Asian demographic. Ann R Coll Surg Engl. 2012;94(3):165-9. 19. Channa NA, Soomro AM, Ghangro AB. Cholecystectomy is becoming an increasingly common operation in Hyderabad and adjoining areas. Rawal Med J 2007, 32(2):128–130. 20. Park JW, Kim KH, Kim SJ, et al. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible? Surg Endosc. 2017 Jun 7. doi: 10.1007/s00464-017-5604-z. 21. Rao RV, Kumar A, Sikora SS, et al. Xanthogranulomatous cholecystitis: differentiation from associated gallbladder carcinoma. Trop Gastroenterol 2005;26:31–3. 22. Sánchez-Pobre P, López-Ríos Moreno F, Colina F, et al. Eosinophilic cholecystitis: an infrequent cause of cholecystectomy. Gastroenterol Hepatol. 1997;20(1):21-3. 23. Matos AS, Baptista HN, Pinheiro C, et al. Gallbladder polyps: how should they be treated and when? Rev Assoc Med Bras (1992). 2010;56(3):318-21. 24. Cha BH, Hwang JH, Lee SH, et al. Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol 2011; 17: 2216-22. 25. Park KW, Kim SH, Choi SH, et al. Differentiation of nonneoplastic and neoplastic gallbladder polyps 1 cm or bigger with multidetector row computed tomography. J Comput Assist Tomogr 2010; 34: 135-9. 26. Andrén-Sandberg A. Diagnosis and Management of Gallbladder Polyps. N Am J Med Sci 2012; 4: 203-11. 27. SAGES Guideline Committee. SAGES guidelines for the clinical application of laparoscopic tract surgery, section H – gallbladder polyps. January 2010. Available at http://www.sages.org/publications/id/06/. 28. Dairi S, Demeusy A, Sill AM, et al. Implications of gallbladder cholesterolosis and cholesterol polyps? J Surg Res. 2016;200 (2):467-72. 29. T. Ozgur, S. Toprak, A. Koyuncuer, M. et al. Do histopathological findings improve by increasing the sample size in chole-cystectomies. World J Surg Oncol. 2013;11:245. 30. Parrilla Paricio P, Garcia Olmo D, Pellicer Franco E, et al. Gallbladder cholesterolosis: an aetiological factor in acute pancreatitis of uncertain origin. Br J Surg 1990; 77:735. 31. Khairy GA, Guraya SY, Murshid KR. Cholesterolosis. Incidence, correlation with serum cholesterol level and the role of laparoscopic cholecystectomy. Saudi Med J 2004;25:1226. 32. Yaylak F, Deger A, Ucar BI, et al. Cholesterolosis in routine histopathological examination after cholecystectomy: what should a surgeon behold in the reports? Int J Surg. 2014;12(11):1187-91 33. Roa I, de Aretxabala X, Ibacache G, et al. Association between cholesterolosis and gallbladder cancer. Rev Med Chil. 2010;138(7):804-8. 34. Wang X, Magkos F, Mittendorfer B. Sex differences in lipid and lipoprotein metabolism: it's not just about sex hormones. J Clin Endocrinol Metab. 2011;96(4):885-93. 35. Hassan EH, Gerges SS, El-Atrebi KA, et al. pylori infection in gall bladder cancer: clinicopathological study. Tumour Biol. 2015;36(9):7093-8. 36. Dix FP, Bruce IA, Krypcyzk A, et al. A selective approach to histopathology of the gallbladder is justifiable. Surgeon 2003; 1: 233–235. 37. Grobmyer SR, Lieberman MD, Daly JM. Gallbladder cancer in the twentieth century: single institution’s experience. World J Surg 2004; 28: 47–49. 38. Solaini L, Sharma A, Watt J et al. Predictive factors for incidental gallbladder dysplasia and carcinoma. J Surg Res 2014; 189: 17–21. 39. Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg 2000; 7: 556–567. 40. Hart J, Modan B, Shani M. Cholelithiasis in the aetiology of gallbladder neoplasms. Lancet 1971; 1: 1,151–1,153. 41. Sujata J, Rana S, Sabina K et al. Incidental gall bladder carcinoma in laparoscopic cholecystectomy: a report of 6 cases and a review of the literature. J Clin Diagn Res 2013; 7: 85–88. 42. Deng YL, Xiong XZ, Zhou Y et al. Selective histology of cholecystectomy specimens–is it justified? J Surg Res 2015; 193: 196–201. 43. Swank HA, Mulder IM, Hop WC, et al. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review. Surg Endosc 2013; 27: 4,439–4,448. 44. Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg 1996;224: 639–646. 45. Choi SB, Han HJ, Kim CY, et al. Incidental gallbladder cancer diagnosed following laparoscopic cholecystectomy. World J Surg. 2009;33(12):2657-63.
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Details

Subjects Health Care Administration
Journal Section Articles
Authors

Erdal Uysal

Efe Sezgin

Hasan Bakir This is me

Ahmet Gurer This is me

Mehmet Sokucu This is me

Publication Date September 22, 2017
Acceptance Date September 14, 2017
Published in Issue Year 2017 Volume: 9 Issue: 3

Cite

APA Uysal, E., Sezgin, E., Bakir, H., Gurer, A., et al. (2017). Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center. Konuralp Medical Journal, 9(3), 243-249. https://doi.org/10.18521/ktd.325651
AMA Uysal E, Sezgin E, Bakir H, Gurer A, Sokucu M. Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center. Konuralp Medical Journal. September 2017;9(3):243-249. doi:10.18521/ktd.325651
Chicago Uysal, Erdal, Efe Sezgin, Hasan Bakir, Ahmet Gurer, and Mehmet Sokucu. “Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center”. Konuralp Medical Journal 9, no. 3 (September 2017): 243-49. https://doi.org/10.18521/ktd.325651.
EndNote Uysal E, Sezgin E, Bakir H, Gurer A, Sokucu M (September 1, 2017) Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center. Konuralp Medical Journal 9 3 243–249.
IEEE E. Uysal, E. Sezgin, H. Bakir, A. Gurer, and M. Sokucu, “Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center”, Konuralp Medical Journal, vol. 9, no. 3, pp. 243–249, 2017, doi: 10.18521/ktd.325651.
ISNAD Uysal, Erdal et al. “Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center”. Konuralp Medical Journal 9/3 (September 2017), 243-249. https://doi.org/10.18521/ktd.325651.
JAMA Uysal E, Sezgin E, Bakir H, Gurer A, Sokucu M. Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center. Konuralp Medical Journal. 2017;9:243–249.
MLA Uysal, Erdal et al. “Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center”. Konuralp Medical Journal, vol. 9, no. 3, 2017, pp. 243-9, doi:10.18521/ktd.325651.
Vancouver Uysal E, Sezgin E, Bakir H, Gurer A, Sokucu M. Is Routine Histopathological Gallbladder Examination Necessary After Cholecystectomy? Evaluation of the Results of 1,366 Cholecystectomy Specimens in Single Center. Konuralp Medical Journal. 2017;9(3):243-9.