Abstract
Background: Laparoscopic cholecystectomy (LC) has become the standard treatment for symptomatic cholelithiasis. Bile duct injury and accidental gallbladder perforation with spillage of bile and stone are common complications of LC. This study was carried out to assess the early complications of gallbladder perforation during LC, and identify the risk factor of that perforation.
 Objectives: to evaluate the early complications which may occur after the perforation of the gallbladder during laparoscopic cholecystectomy and to determine the risk factors which are associated with the perforation of the gall bladder. 
 Subjects and methods: A prospective comparative study on 192 patients who underwent LC between August 2012 to January 2014 in Baghdad teaching hospital. Data were collected, Patients with and without gallbladder perforation were compared in terms of gender, age, anatomic difficulty, the experience of the surgeon, omental and other organ adhesions to the gall bladder.
 Results: fifty-five patients had a perforation of GB during LC, 46 patients had GB perforated during dissection of gallbladder bed from hepatic fossa. The mean operative time and duration of postoperative hospitalization were longer in the perforated group, perforation occurs more frequently in acute cholecystitis compared to chronic cholecystitis. There were significant risk factors related to gallbladder perforation which include male gender, AC, adhesion around the gallbladder, and experience of the surgeon.
 Conclusion: accidental gallbladder perforation leading to longer operative and hospital time which loss the advantage of LC. The male gender, AC, and experience of the surgeon had the main risk factors of the perforated gallbladder.
Highlights
Laparoscopic cholecystectomy is the cornerstone of the management of biliary disease and cholecystitis but is one of the commonest operations in both elective and emergency surgery
Conclusion: accidental gallbladder perforation leading to longer operative and hospital time which loss the advantage of Laparoscopic cholecystectomy (LC)
(2) It has a clear advantage over the traditional approach with decreased morbidity, less pain, and quicker recovery; it remains associated with a three- to five-fold increase in bile duct injury (BDI). [3,4] the traditional absolute contraindications for laparoscopic cholecystectomy in certain specialized situations have largely been resolved and rendered relative, including the presence of acute cholecystitis, a history of previous abdominal surgery, morbid obesity, pregnancy, cirrhosis, and even situs inversus totali. [5,6] Operative conversion from Laparoscopic cholecystectomy to open cholecystectomy is 1%15%. [7] Two previous reviews agreed on only two important risk factors when considering conversion, namely, male gender and old age. [7,8] Acute cholecystitis, a gallbladder wall thickness > 3 mm and a history of previous surgeries is all predictive factors for conversion. [9]
Summary
Laparoscopic cholecystectomy is the cornerstone of the management of biliary disease and cholecystitis but is one of the commonest operations in both elective and emergency surgery. It offers an unquestionable advantage over open cholecystectomy to the patient and the health care system. Critical View of Safety (CVS) is considered one of the most important methods to prevent bile duct injury; it is advised by many international societies and has been the standard of care. Objectives: to evaluate the early complications which may occur after the perforation of the gallbladder during laparoscopic cholecystectomy and to determine the risk factors which are associated with the perforation of the gall bladder
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