Surgical outcomes of laparoscopic cholecystectomy in scleroatrophic gallbladders

Macroscopic appearance of the gallbladder is an important factor in laparoscopic cholecystectomy. The aim of this study was to evaluate surgical outcomes in patients with scleroatrophic gallbladders who underwent laparoscopic cholecystectomy.

From 2002-2007, 295 patients were found to have a scleroatrophic gallbladder during laparoscopic cholecystectomy. Investigated variables included gender, age, body mass index, preoperative ultrasound evidence of gallbladder wall thickening, number of gallstones, diameter of common bile duct, preoperative endoscopic retrograde cholangiopancreatography, surgeon's experience, gallbladder adhesion score, drain use, conversion rate, operative time, intraoperative and postoperative complications, mortality, and length of hospital stay.

Most of the patients were male (56.3%). Overall mean age was 55.50 ± 13.75 years. Mean body mass index was 27.91 ± 4.43 kg/m2. Based on preoperative ultrasound findings, thickened gallbladder wall was present in 30.8% of patients, dilated common bile duct in 30.2%, and multiple gallstones in 83.1%. Preoperative endoscopic retrograde cholangiopancreatography was performed in 32.5% of patients. High-grade adhesions (≥ III) were encountered in 68.1% of patients. The conversion rate was 23.1%. The overall intraoperative complication rate was 31.5%. Drains were used in 63.7% of patients. Mean operative time was 65.2 ± 32.6 minutes. The rate of postoperative complications was 9.5%. Median hospital stay was 1 day (range: 1-31 days). Mortality occurred in three patients (1.0%).

This study demonstrates that scleroatrophic gallbladders present more difficulties for laparoscopic cholecystectomy and are associated with a higher conversion rate. Therefore, it is highly important that patients whose preoperative imaging studies suggest a scleroatrophic gallbladder be referred to an experienced center for hepato-biliary surgery.