Clinical outcomes of naval aviation personnel with cholelithiasis

Background: This study examines the aeromedical outcomes of aviation personnel with asymptomatic cholelithiasis or those treated successfully with conventional (open) cholecystectomy (CC), laparoscopic cholecystectomy (I-C), or extracorporeal shock wave lithotripsy (ESWL) for previous symptomatic cholecystitis. Methods: The Biomedical Database of the Naval Aerospace Medical Institute was searched for waiver requests for asymptomatic gallstones, acute cholecystitis, and cholecystectomy. Microfiche records were then reviewed. The rates of development of symptomatic disease and need for cholecystectonny or ESWL were noted in aircrew granted waivers for asymptomatic cholelithiasis. The aeromedical outcomes of aircrew who underwent treatment for symptomatic disease by cholecystectonny (CC or LC) or ESWL were reviewed. Results: A search of the Biomedical Database revealed waiver requests for cholelithiasis for 79 naval aviation personnel from April 1988 to August 2000. Waiver requests were for previous cholecystectomy in 56 (70.9%) and cholelithiasis in 23 (29.1%). No aviators had undergone ESWL. Of the 56 aviators with previous cholecystectomy, waivers were granted in 51 (91.1%) cases. Waivers were denied to five individuals, primarily for other medical problems. Of the 23 aviators with cholelithiasis, 11 (47.8%) were granted waivers. Waivers were denied in 12 aviators because of symptomatic cholelithiasis (5), asymptomatic cholelithiasis (1), common bile duct stone (1), other medical problems (3), or no explanation (2). The aviator with asymptomatic cholelithiasis and two of the aviators with symptomatic cholelithiasis were subsequently granted waivers after cholecystectonny (I-C). The aviator with a symptomatic common bile duct stone received a waiver after cholecystectomy (CC). A total of 66 (83.5%) aviators received waivers. None were revoked during the study period because of symptomatic cholelithiasis or retained common bile duct stones. Conclusions: Aviation personnel who receive waivers for asymptomatic cholelithiasis or cholecystectomy rarely present with symptomatic biliary disease.