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Gallbladder perforation with fistulous communication.

Alejandro Quiroga-Garza^1,2, Neri Alejandro Alvarez-Villalobos^3,4, Milton Alberto Muñoz-Leija^1,5

¹Human Anatomy Department, Universidad Autonoma de Nuevo Leon, School of Medicine, Monterrey 64460, Nuevo Leon, Mexico.

World Journal of Gastrointestinal Surgery

|July 5, 2023

Summary

Management of gallbladder perforation (GBP) with fistulous communication is debated. Both open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) are suitable surgical options for GBP, showing no significant differences in outcomes.

Keywords:

Fistulous communication Gallbladder perforation Laparoscopic cholecystectomy Open cholecystectomy

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Area of Science:

Surgical Gastroenterology
Abdominal Surgery
Hepatobiliary Surgery

Background:

Gallbladder perforation (GBP) with fistulous communication, specifically Neimeier type I, presents management challenges.
The optimal surgical approach for this condition remains a subject of controversy in clinical practice.

Purpose of the Study:

To recommend evidence-based management strategies for gallbladder perforation (GBP) with fistulous communication.
To compare the efficacy and outcomes of different surgical interventions for Neimeier type I GBP.

Main Methods:

A systematic review adhering to PRISMA guidelines was conducted.
Studies were identified through comprehensive searches in Scopus, Web of Science, MEDLINE, and EMBASE databases.
Data on patient demographics, interventions, hospitalization duration, complications, and fistula location were extracted.

Main Results:

54 patients with Neimeier type I GBP were analyzed, with abdominal wall fistulas being most common.
Open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) showed comparable complication rates in case reports/series.
OC was associated with longer hospitalization (mean 26.3 days vs. 6.6 days), while mortality data was limited.

Conclusions:

Both open cholecystectomy (OC) and laparoscopic cholecystectomy (LC) are viable surgical options for managing gallbladder perforation (GBP) with fistulous communication.
Surgeons should weigh the specific advantages and disadvantages of each therapeutic approach.
No significant differences were found between OC and LC in the overall management of Neimeier type I GBP.