Can early laparoscopic cholecystectomy be the optimal management of cholecystitis with gallbladder perforation? A single institute experience of 74 cases

Hung-Chieh Lo, Yu-Chun Wang, Li-Ting Su, Chi-Hsun Hsieh

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Gallbladder perforation is a rare but serious complication of cholecystitis. It was usually managed by percutaneous gallbladder drainage (PTGBD) followed by elective cholecystectomy. However, evidences are emerging that early laparoscopic cholecystectomy (LC) is still feasible under these conditions. We hypothesized that early LC may have comparable surgical results as to those of PTGBD + elective LC. Material and methods: From January 2005 to October 2011, patients admitted to China Medical University Hospital with a diagnosis of perforated cholecystitis were retrospectively reviewed. The diagnosis of gallbladder perforation was made by image and/or intraoperative findings. Those patients who had unstable hemodynamics that were not fitted for general anesthesia or those who had concomitant major operations were excluded. Patients were divided into three groups: early open cholecystectomy (group 1), early LC (group 2), and PTGBDfollowed by elective LC (group 3). The demographic features, surgical results, and patient outcome were analyzed and compared between groups. Results: A total of 74 patients were included. All patients had similar demographic features except that patients in group 2 were younger (62 vs. 72 and 73.5 years) compared with group 1 and group 3 (p = 0.016). There were no differences in terms of operative time, blood loss, conversion, and complication rate between three groups. The length of hospital stay (LOS) was significant shorter in group 2 patients compared with that of groups 1 and 3. Conclusions: Although PTGBD followed by elective LC was still the mainstay for the treatment of gallbladder perforation, early LC had comparable surgical outcomes as that of PTGBD + LC but with a significantly shorter LOS. Early LC should be considered the optimal treatment for gallbladder perforation, and PTGBD + LC can be preserved for those who carried a high risk of operation. © Springer Science+Business Media, LLC 2012.
Original languageEnglish
Pages (from-to)3301-3306
Number of pages6
JournalSurgical Endoscopy and Other Interventional Techniques
Volume26
Issue number11
DOIs
Publication statusPublished - 2012
Externally publishedYes

Keywords

  • Cholecystectomy
  • Cholecystitis
  • Drainage
  • Laparoscopy
  • Perforation
  • adult
  • aged
  • cholecystectomy
  • cholecystitis
  • clinical effectiveness
  • controlled study
  • disease association
  • early intervention
  • elective surgery
  • female
  • gallbladder perforation
  • high risk patient
  • human
  • intermethod comparison
  • length of stay
  • major clinical study
  • male
  • operation duration
  • outcome assessment
  • percutaneous transhepatic drainage
  • postoperative hemorrhage
  • priority journal
  • retrospective study
  • review
  • surgical mortality
  • surgical risk
  • Aged
  • Aged, 80 and over
  • Cholecystectomy, Laparoscopic
  • Early Medical Intervention
  • Female
  • Gallbladder Diseases
  • Humans
  • Male
  • Middle Aged
  • Retrospective Studies
  • Rupture, Spontaneous

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