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Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae
T T Hui1, D I Giurgiu, D R Margulies
1Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Insights
Iatrogenic gallbladder perforation during laparoscopic cholecystectomy (LC) is common (36%), linked to factors like inflammation and difficult dissections. Most perforations resulted from grasper traction or electrocautery, with no increased wound infection risk observed.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Patient Safety
Background:
- Iatrogenic gallbladder perforation (PGB) during laparoscopic cholecystectomy (LC) can cause bile and gallstone spillage.
- This spillage may lead to serious postoperative infections.
Purpose of the Study:
- To prospectively evaluate risk factors, mechanisms, and complications of PGB during LC.
- To assess long-term outcomes following PGB.
Main Methods:
- Prospective data collection from 1412 patients undergoing LC (1989-1995).
- Comparison of patients with and without PGB.
- Long-term follow-up via questionnaires and telephone interviews (average 48 months).
Main Results:
- PGB occurred in 36% of patients.
- Risk factors included male sex, higher weight, gallbladder inflammation, thickening, adhesions, and difficult hilar dissection.
- Grasper traction (55%) and electrocautery (40%) were primary mechanisms.
- PGB group had longer operating times and hospital stays.
- No significant difference in wound infection rates (1.6% vs 1.8%).
- One early intra-abdominal abscess; no late abscesses or retained gallstone complications found.
Conclusions:
- Several factors increase PGB risk during LC.
- While PGB prolongs surgery and hospital stay, it does not elevate wound infection rates.
- Long-term complications from PGB appear minimal.
Abstract:
Iatrogenic perforation of the gallbladder (PGB) during laparoscopic cholecystectomy (LC) leads to spillage of bile and gallstones into the peritoneal cavity, which can result in serious postoperative infection. The objective of this study is to prospectively evaluate with long-term follow-up the risk factors, mechanisms, and complications associated with PGB in patients undergoing LC. Data from 1412 patients undergoing LC were collected prospectively between 1989 and 1995. Patients with and without iatrogenic gallbladder perforation were compared. Long-term follow-up was obtained using mailed questionnaires and telephone interviews, when needed. Of the 1412 patients, 512 (36%) sustained a PGB. Male sex, weight, gallbladder inflammation, thickening of the gallbladder, presence of adhesions, and a difficult hilar dissection were all associated with an increased incidence of PGB. The most common mechanisms of PGB were laceration due to grasper traction (55%) and electrocautery dissection (40%). Both the operating time and length of hospital stay were significantly longer in the PGB group. No difference was observed in the rate of wound infections between PGB and non-PGB patients (1.6% versus 1.8%). Only one patient (with an inflamed and perforated gallbladder) developed an early postoperative intra-abdominal abscess. Long-term follow-up averaging 48 months was achieved with a response rate of 44 per cent. No late intra-abdominal abscesses or complications attributable to retained gallstones were discovered.