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Xanthogranulomatous cholecystitis in laparoscopic surgery
1Department of General Surgery, Regional General Hospital, No. 1 "Gabriel Mancera," Mexican Institute of Social Security, Mexico City, Mexico. quzvaldi@yahoo.com
Insights
Xanthogranulomatous cholecystitis (XGC) complicates cholecystectomy, often requiring conversion to open surgery due to laparoscopic difficulties. Preoperative suspicion of XGC warrants consideration of open cholecystectomy for patient safety.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Surgery
Background:
- Xanthogranulomatous cholecystitis (XGC) is an uncommon inflammatory condition of the gallbladder.
- It presents a diagnostic and surgical challenge, particularly during cholecystectomy.
Observation:
- A retrospective review of 12,426 cholecystectomies identified 182 cases of XGC (1.46%).
- Of 41 XGC patients undergoing laparoscopic surgery, 88% had chronic conditions, 85% had lithiasis, and 22% had jaundice.
- 36 patients (88%) had chronic conditions, 85% had lithiasis, and 22% had jaundice.
Findings:
- Laparoscopic surgery for XGC was associated with significant technical difficulties.
- 80% of laparoscopic cases required conversion to open surgery.
- 64% of converted cases involved partial cholecystectomy.
Implications:
- XGC poses considerable challenges during laparoscopic cholecystectomy.
- Preoperative suspicion of XGC should prompt consideration of a primary open surgical approach.
- This approach may improve surgical outcomes and reduce complications.
Abstract:
Xanthogranulomatous cholecystitis (XGC) is one presentation of cholecystitis and can be a cause of difficulty in cholecystectomy. We reviewed the clinical files of 12,426 patients who had undergone cholecystectomy. In this group, there were 182 cases of XGC, and 41 of these patients had undergone laparoscopic surgery. Patients with XGC represented 1.46% of the cholecystectomies that were performed. Of the 41 patients who underwent laparoscopic surgery, 27 were men (66%) and 14 were women (34%) (average age, 52 years). A total of 36 patients (88%) presented with a chronic condition. XGC was found to be associated with lithiasis in 85%, with jaundice in 22%, and with cancer in 2.4% (one patient). A total of 33 patients (80%) required conversion to open surgery, because of technical difficulties; of these patients, 64% underwent partial cholecystectomy. We conclude that XGC creates difficulty at laparoscopy and therefore any preoperative suspicion of XGC should cause the clinician to consider open cholecystectomy.
