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Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience
Gautham Krishnamurthy1, Senthil Ganesan1, Jayapriya Ramas1
1Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India.
Insights
Early laparoscopic cholecystectomy is a safe and feasible treatment for acute gallbladder perforation (GBP). This approach, particularly the retroinfundibular technique, effectively manages complex cases, offering a viable alternative to traditional methods.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Acute Care Surgery
Background:
- Acute gallbladder perforation (GBP) presents significant mortality and morbidity risks.
- Current management often involves percutaneous drainage followed by delayed cholecystectomy.
- The efficacy of early surgical intervention, especially laparoscopic approaches, in GBP remains underexplored.
Purpose of the Study:
- To evaluate the feasibility and outcomes of early laparoscopic cholecystectomy in patients with acute gallbladder perforation.
- To assess the utility of the retroinfundibular technique in managing challenging GBP cases.
Main Methods:
- Retrospective analysis of 15 patients with acute GBP from April 2014 to December 2018.
- Review of clinical data, preoperative imaging, surgical procedures, and outcomes.
- Surgical videos were analyzed for detailed operative findings.
Main Results:
- Laparoscopic cholecystectomy was successfully completed in 12 out of 15 patients (80%).
- The retroinfundibular technique was employed in 80% of cases, proving useful for difficult dissections.
- No mortalities were recorded, with a median postoperative hospital stay of 3 days.
Conclusions:
- Early laparoscopic cholecystectomy is a safe and feasible option for acute GBP in experienced centers.
- The retroinfundibular technique is beneficial for laparoscopic management of GBP, especially in cases with a 'frozen Calot's triangle'.
Background:
Acute gallbladder perforation (GBP) is associated with significant mortality and morbidity. Percutaneous drainage followed by interval cholecystectomy has been the preferred management. The outcomes of early surgery, especially by laparoscopy, have not been well studied in GBP. We present our experience in early laparoscopic cholecystectomy in GBP.
Methodology:
A retrospective analysis of patients admitted with GBP between April 2014 and December 2018 was done. Clinical presentation, preoperative imaging, surgical procedure, operative findings and the outcomes in these patients were analysed. Video of the surgeries was reviewed in case of the absence of data from the case records.
Results:
Fifteen patients were treated for GBP during the study period. Eleven patients were male, and the mean age was 61 years. Fourteen patients (93.3%) had associated co-morbidities. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock were present in 3, 3, 6 and 3 patients, respectively. The location of the collection was gallbladder fossa, pericholecystic, subhepatic and diffuse in 3, 5, 4 and 3 patients, respectively. Intraoperatively, 13 patients were detected to have perforation at the fundus of the gallbladder. Cystic duct stump was managed with clip, endoloop, suturing and external drainage in 7, 2, 5 and 1 patient, respectively. Laparoscopic cholecystectomy was completed in 12 (80%) patients. Retroinfundibular technique was used in 12 (80%) patients. There was one conversion. Two patients required endoscopic retrograde cholangiogram + bile duct stenting, and one was reexplored for cystic artery bleed. There were no mortalities. The median duration of post-operative hospital stay and drain removal was 3 (1-19) and 3 (1-6), respectively.
Conclusion:
Early laparoscopic cholecystectomy in acute GBP is feasible and can be safely performed in centres having sufficient expertise. Retroinfundibular technique of laparoscopic cholecystectomy is useful in tackling frozen Calot's triangle in GBP.
