Laparoscopic cholecystectomy in patients with porcelain gallbladder based on the preoperative ultrasound findings

Porcelain gallbladder is considered a relative contraindication to laparoscopic cholecystectomy, because of a high incidence of gallbladder cancer or gastrointestinal cancer. We examined the management of laparoscopic cholecystectomy in patients with porcelain gallbladder.

1,608 patients underwent cholecystectomy and 13 (0.81%) patients had porcelain gallbladder. All patients underwent preoperative spiral computed tomography after intravenous infusion cholangiography and intraoperative cholangiography. Patients with porcelain gallbladder were classified as Type I to III according to preoperative ultrasound findings. The Type I porcelain gallbladder was indicated for laparoscopic cholecystectomy and Type II porcelain gallbladder was selected for open cholecystectomy.

The laparoscopic cholecystectomy was completed in 10 patients with Type I porcelain gallbladder and the microscopie diagnosis demonstrated no cancer in the calcified wall of the gallbladder. In one patient with a non-transected injury to the right hepatic duct, a T-drainage tube was inserted at the site of the injury using the laparoscopic technique. Three patients with Type II porcelain gallbladder underwent open cholecystectomy and one patient had gallbladder cancer, therefore additional hepatectomy and lymphadenectomy was performed.

We conclude that patients with a Type I porcelain gallbladder should be considered for laparoscopic cholecystectomy using a preoperative selection based on the ultrasound findings.