Xanthogranulomatous Cholecystitis: Is Surgery Difficult? Is Laparoscopic Surgery Recommended?

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Xanthogranulomatous cholecystitis (XGC) is a rare, severe gallbladder inflammation.
• XGC poses surgical difficulties due to its varied clinical, radiological, and intraoperative characteristics.
• Distinguishing XGC from gallbladder carcinoma (GBC) preoperatively is challenging.

Purpose of the Study:

• To highlight the surgical complexities associated with Xanthogranulomatous cholecystitis.
• To evaluate the efficacy and safety of laparoscopic surgery for XGC.
• To determine the conversion rate from laparoscopic to open surgery in XGC cases.

Main Methods:

• Retrospective review of histological findings from 3339 cholecystectomy patients (January 2015 - January 2020).
• Analysis of clinical, radiological, and intraoperative data for 70 patients diagnosed with XGC.
• Comparison of laparoscopic versus open surgical outcomes for XGC.

Main Results:

• XGC was identified in 70 patients (2.09%), with a mean age of 53.75 years and a M:F ratio of 1.2.
• Radiological findings included gallstones (94.2%) and thickened GB walls (58.5%).
• Laparoscopic surgery was initiated in 66 patients, with 14 (21.2%) converted to open surgery due to dissection difficulties, particularly in Calot's triangle.

Conclusions:

• XGC surgery is challenging due to its presentation and potential to mimic GBC.
• Laparoscopic cholecystectomy is a viable option for suspected XGC, despite a notable conversion rate.
• Careful patient selection and surgical expertise are crucial for managing XGC laparoscopically.