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Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience
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 presen...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083746/ https://www.ncbi.nlm.nih.gov/pubmed/33723178 http://dx.doi.org/10.4103/jmas.JMAS_176_19 |
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author | Krishnamurthy, Gautham Ganesan, Senthil Ramas, Jayapriya Damodaran, Karthikeyan Khanna, Aswin Patta, Radhakrishna |
author_facet | Krishnamurthy, Gautham Ganesan, Senthil Ramas, Jayapriya Damodaran, Karthikeyan Khanna, Aswin Patta, Radhakrishna |
author_sort | Krishnamurthy, Gautham |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-8083746 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-80837462021-05-06 Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience Krishnamurthy, Gautham Ganesan, Senthil Ramas, Jayapriya Damodaran, Karthikeyan Khanna, Aswin Patta, Radhakrishna J Minim Access Surg Original Article 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. Wolters Kluwer - Medknow 2021 2020-03-28 /pmc/articles/PMC8083746/ /pubmed/33723178 http://dx.doi.org/10.4103/jmas.JMAS_176_19 Text en Copyright: © 2020 Journal of Minimal Access Surgery https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Krishnamurthy, Gautham Ganesan, Senthil Ramas, Jayapriya Damodaran, Karthikeyan Khanna, Aswin Patta, Radhakrishna Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title | Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title_full | Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title_fullStr | Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title_full_unstemmed | Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title_short | Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience |
title_sort | early laparoscopic cholecystectomy in acute gallbladder perforation: single-centre experience |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083746/ https://www.ncbi.nlm.nih.gov/pubmed/33723178 http://dx.doi.org/10.4103/jmas.JMAS_176_19 |
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