Incidence Of Gallbladder Perforation Research Articles

Gallbladder perforation in acute acalculous vs. calculous cholecystitis: a retrospective comparative cohort study with 10-year single-center experience.

Gallstones are a well-known risk factor for acute cholecystitis. However, their role as a risk factor for gallbladder perforation (GBP) remains unclear. Therefore, this study aimed to determine the effect of gallstones on the development of GBP. This large-scale retrospective cohort study enroled consecutive patients who underwent cholecystectomy for acute cholecystitis. The primary endpoint was the role of gallstones as a risk factor for developing GBP. Secondary endpoints included the clinical characteristics of GBP, other risk factors for GBP, differences in clinical outcomes between patients with acalculous cholecystitis (AC) and calculous cholecystitis (CC), and the influence of cholecystectomy timing. A total of 4497 patients were included in this study. The incidence of GBP was significantly higher in the AC group compared to the CC group (5.6% vs. 1.0%, P <0.001). However, there were no differences in ICU admission and hospital stay durations. The incidence of overall complications was significantly higher in the AC group than in the CC group (2.2% vs. 1.0%, P <0.001). Patients with AC had a higher risk of developing GBP than those with CC (odds ratio, 5.00; 95% CI, 2.94-8.33). In addition, older age (≥60years), male sex, comorbidities, poor performance status, and concomitant acute cholangitis were associated with the development of GBP. Furthermore, the incidence of GBP was significantly higher in the delayed cholecystectomy group than in the early cholecystectomy group (2.0% vs. 0.9%, P <0.001). AC is a significant risk factor for GBP. Furthermore, early cholecystectomy can significantly reduce GBP-related morbidity and mortality.

Incidence, Risk Factors and Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy

Background and Aim: Gallbladder perforation has been recorded in patients undergoing laparoscopic cholecystectomy and associated with the development of gallstones and bile leakage. The present study investigated the incidence, risk factors, and outcome of gallbladder perforation in patients undergoing elective laparoscopic cholecystectomy. Patients and Methods: This prospective study was conducted on 156 patients who underwent laparoscopic cholecystectomy in the department of General Surgery, Federal Government Polyclinic Hospital, Islamabad from January 2021 to July 2022. Gallbladder stone patients with chronic symptoms such as vomiting, recurrent episodes of epigastric, nausea, and hypochondrial pain on right side were included. Acute cholecystitis patients with single or multiple gallstone disease were also enrolled. All the patients were prepared for laparoscopic cholecystectomy and investigations such as blood sugar, liver function test, CBC, blood urea and creatinine, ultrasound of gallbladder, and ECG were done. SPSS version 26 was used for data analysis. Results: Of the total 156 patients, there were 126 (80.8%) females and 30 (19.2%) male. Age-wise distribution of patients were as follows: 66 (42.3%) in 20-35 years, 52 (33.3%) in 36-50 years, and 38 (24.4%) in 51-65 years. The incidence of single gall stone (SGS), multi gallstones (MGS), and acute cholecystitis was 48 (30.8%), 88 (56.4%), and 20 (12.8%) respectively. The overall mean age was 36 years. The incidence of gallbladder perforation was 26.9% (n=42) among all patients. Patients distribution based on gallbladder perforation were as follows: 17 (10.9%) in MGS, 14 (9.0%) in SGS, and 11 (7.1%) in acute cholecystitis cases. Conclusion: The present study found that the prevalence of gallbladder perforation was 26.9% among SGS, MGS, and acute cholecystitis. Majority of GB perforation occurred during gallbladder bed dissection. Acute cholecystitis patients are more prone to GB perforation. GB perforation can be reduced by utilization of harmonic scalpel in laparoscopic cholecystitis. Keywords: Elective laparoscopic cholecystectomy, Gallbladder perforation, Outcomes

GALLBLADDER PERFORATION: EXPERIENCE OF 35 CASES AT A TERTIARY CARE HOSPITAL

Introduction: Gall bladder stone disease is one of the commonest hepatobiliary disease encountered in any general surgical outdoor worldwide especially in fertile females who are obese and in their 4th or 5th decade of life. One of the complications can be gallbladder perforation, although can be a sequel to acalcular cholecystitis. In India, incidence of Gall bladder perforation is estimated to be around 4%. There has been a marked increase in the incidence of the gallstone in the West during the past century. Material and Methods: The aim of our study was to highlight the Etiopathogenesis, Diagnosis, Management and Complications of gall bladder perforations. Results: In our study 35 patients were studied ageing between 25-80 years of age with a mean age of 54.3+14.53 years. Majority of our study patients i.e. 13 (37.1%) aged &gt;60 years. Type 2 GB perforation was seen in 30 (85.7%) patients, followed by Type 1 in 3 (86% patients while as 2 (5.7%) patients were found to have Type 3 GB perforation. Percutaneous drainage of gall bladder was done in majority 30 (85.7%) patients. Conclusion: Type II gallbladder perforation is the most common type. Contrast- enhanced CT has an important role in diagnosing gallbladder perforation. Early suspicion, diagnosis, and appropriate management are of crucial importance for a better outcome in patients with gall bladder perforation.

Incidence of gall bladder perforation in cases admitted with acute cholecystitis in tertiary care centre, Puducherry

Aim: To present our clinical experience with gallbladder perforation cases in cases admitted with acute cholecystitis.Methods: Records of 75 patients who received medical andor surgical treatment with the diagnosis of acute cholecystitis in Sri Venkateswara medical college hospital and research centre, Ariyur, Puducherry between November 2020 to August 2021 were reviewed retrospectively. Five (6.6%) of those patients had gallbladder perforation. The parameters including age, gender, time from the onset of symptoms to the time of surgery, diagnostic procedures, surgical treatment, morbidity, and mortality were evaluated.Results: One patient had type I gallbladder perforation, 4 type II gallbladder perforation according to Niemeier’s classification. The patients underwent surgery after administration of intravenous fluids, analgesics and antibiotics after admission.Conclusion: Early diagnosis and emergency surgical treatment of gallbladder perforation are of crucial importance. Upper abdominal computerized tomography for acute cholecystitis patients may contribute to the preoperative diagnosis of gallbladder perforation.

Comparative study to evaluate ultrasonic verses monopolar electrocautery dissection of gall bladder in laparoscopic cholecystectomy

Background: Gallstones are one of the most common routinely encountered surgical problem in the developed world. Laparoscopic cholecystectomy being the gold standard surgery for gall stones has been modified various times using different instruments in order to improve intraoperative and postoperative outcomes. The aim of the study was to see clinical outcomes of ultrasonic scalpel verses monopolar electrocautery in dissection of gall bladder in laparoscopic cholecystectomy.Methods: A prospective randomized controlled study was done with total 100 patients in which 50 patients underwent laparoscopic cholecystectomy via ultrasonic scalpel while rest 50 patients were operated using monopolar electrocautery. The study was conducted for a period of eighteen months and clinical outcomes were studied in terms of operative time, frequency of lens cleaning, gall bladder perforation, biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay.Results: The two groups were comparable in terms of demographic profile considering age and sex distribution. However, there was a statistically significant reduction in operative time, frequency of lens cleaning and gall bladder perforation in group A (harmonic scalpel) as compared to group B (electrocautery).Conclusions: Harmonic scalpel is not only a safe and effective instrument but also a reliable alternative to electrocautery. Even though the study revealed no significant difference in biliary leak, common bile duct injury, bowel perforation and postoperative hospital stay but it can significantly reduce operative time and incidence of gall bladder perforation. Thus, it can improve the operative course in laparoscopic cholecystectomy.

The Use of Harmonic Scalpel for Laparoscopic Clip less Cholecystectomy

BACKGROUND: Laparoscopic cholecystectomy (LC) is accepted as the ‘‘gold standard’’ surgical treatment of gallstones. Although surgical clip (SC) is known to be a safe closure method for cystic duct and artery, bile leakage due to clip displacement from the cystic duct stump is a potential complication. In recent years, some energy sources have been tried for the closure of the cystic duct. After the beginning of the use of a harmonic scalpel (HS) for sealing of the cystic artery, surgeons started to investigate the role of HS for sealing the cystic duct. The aim of this study was to assess the efficacy and safety of the use of HS in performing LC.&#x0D; OBJECTIVE: To assess the safety and efficacy of HS, as an effective alternative to clipping, for achieving perfect haemobilliary stasis in LC.&#x0D; MATERIAL AND METHODS: This study was carried out on 70 patients over a period of 2 years. It included 29 males and 41 females with a mean age of 40.6±12.3 years. Most of the cases (42.9%) were operated within 35-44 minutes with a range of 25-64 minutes.&#x0D; RESULTS: LC was successful in all patients, with no need to convert into open technique. Gall bladder (GB) perforation occurred in 8.6% of cases. None of the patients had intraoperative cystic duct leaks. Postoperative drainage was haemoserous in all patients with no bile or frank blood. The mean hospital stay was 1.3±0.72 days.&#x0D; CONCLUSION: Harmonic scalpel is a safe and effective alternative to clipping for LC, ensuring perfect haemobilliary stasis. It has the advantages of a lower incidence of GB perforation and shorter operative time. The major limitation is its cost and apprehension of insecurity in using it in mega cystic duct &gt;6 mm.

Ultrasonic Dissection without Cystic Artery Clipping Versus Classical Electro-Dissection in Laparoscopic Cholecystectomy: A Randomized Control Trial

Background: Laparoscopic cholecystectomy is the most common surgery performed for cholelithiasis. Monopolar electrocautery is being used in dissection for so many years. The ultrasonic technique of dissection is useful for safe and faster laparoscopic surgery. Material and Method: We conducted a prospective randomized control trial between classical electrocautery and ultrasonic group. The study included 100 patients over 9 months 12 days. The randomization was done using the envelop method and fifty cases were allocated in each group. The Statistical analysis was done by using the SPSS software (IBM SPSS for windows version 23.0, 2015, Armonk, NY: IBM Corp.). The ordinal data were described using median and Interquartile Range (IQR) and compared using the Chi-Square test and Mann-Whitney U test. Result: The operative time was significantly less in the ultrasonic group (p-value 0.017). VAS score for postoperative pain in the harmonic group was significantly less compared to the classic group (p-value 0.001). The incidence of gallbladder perforation was almost double in the classic group compared to the ultrasonic group but it was statistically not significant (p-value 0.74). The drain was inserted in 14 (28%) patients in the classic group while it was inserted in 7 (14%) patients in the harmonic group, but this difference was not statistically significant (p-value 0.086). The length of hospital stay was not significantly different in the two groups (p=0.89). All patients had no complications and conversion to open surgery Conclusion: Ultrasonic dissection of callot’s triangle and division of the cystic artery without clipping is safe in laparoscopic cholecystectomy. It has certain advantages over electrocautery like shorter operative time and less postoperative pain. However, no additional benefits to decrease the chances of gallbladder perforation, requirement of drain insertion and hospital stay.

Laparoscopic cholecystectomy with harmonic scalpel

Background: The Harmonic scalpel (HS) has been proven to be an effective, efficient, and safe instrument for dissection and hemostasis in both open and laparoscopic surgical procedures. The primary use of the HS in laparoscopic cholecystectomy (LC) has been for the division of the cystic artery and liver bed dissection. Advancements in the Harmonic scalpel blade tip now provide for the reliable ultrasonic division and closure of the cystic duct.Objectives: This study was planned to compare the clips and cautery (CC) method of laparoscopic cholecystectomy (LC) versus LC using HS as regard to the safety and efficacy for symptomatic gallstone disease.Patients and methods: This is a prospective study conducted in Baghdad Teaching Hospital/ 1st Surgical Unit at the Medical City, done on (120) patients within the period between1st October 2010 and 1st October 2011 who underwent LC for symptomatic gallstone disease. These patients have been classified into two groups Group A included 60 patients who underwent the (CC) method, and Group B included 60 patients done by (HS) method. The intraoperative and postoperative parameters were collected including duration of operation, intraoperative blood loss, gallbladder perforation rate, postoperative pain, and complications.Results: HS provides a shorter operative duration than CC (34.85±6.2 min vs. 49.75±9.49 min, respectively, p=0.0001), with a significant less incidence of gallbladder perforation (6.6% vs. 20%; p= 0.032). There was no statistical difference in the conversion rate between both groups. The amount of postoperative drainage is significantly less in HS (37.98±17.25 vs. 49.18±22.65 ml; p = 0.003). No postoperative bile leak was encountered in HS, but it occurred in 3.3% of patients in CC. Visual analog scale (VAS) for pain severity in HS at 24 hours postoperative was (3.95±0.74 vs. 4.94±1.34, p=0.0001).Conclusion: HS provides a complete hemobiliary stasis and is a safe alternative to standard clipping of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation, less operative blood loss, less postoperative pain, and less rate of conversion to open cholecystectomy.

Clinical outcome of clip-less cholecystectomy versus conventional laparoscopic cholecystectomy

Abstract Background: Laparoscopic cholecystectomy is the gold standard worldwide in the surgical treatment of cholecystitis and symptomatic gallstone because it gives well known and more definite advantages if compared with the open procedure. The traditional Laparoscopic cholecystectomy is usually performed by mean of the dissector, the electrosurgical hook, spatula and /or scissor, this method has been used in most centers. Now Harmonic scalpel is used widely to include surgery of head and neck, chest and liver, spleen kidney, adrenal glands colon, rectum and others. Aim: We present this paper in a trial to evaluate the safety, efficacy and clinical outcome of Laparoscopic cholecystectomy using harmonic scalpel for securing cystic duct and artery compared with conventional laparoscopic cholecystectomy . Patients and method: Prospective interventional study was carried out from 1 st February 2012 to 14 th January 2013, 60 patients were included by laparoscopic cholecystectomy for symptomatic gallstone disease at Slemani Teaching Hospital. The primary outcome was the duration of the operation .the second outcome was the conversion rate .The third outcome was perforation of gallbladder during dissection .the fourth outcome was bleeding during the operation and all were reported intra operatively. All possible complications and clinical outcomes in 30 days period compared in both groups. Results: This study was conducted in a period from 1 st February 2012 to 14 th January 2013, during this time sixty patients were included to this prospective randomized study, the patients were divided in to two groups each with 30 patients with the mean age 39.0 ranging from 22 to 66 years. They were 85 % female and the remainder were males with non-significant results statistically regarding age and gender. We found; The mean operative time was (33.17±8.23) in group A and (18.53±2.37) in group B ; p = ˂0.001, The incidence of gall bladder perforation was 43.33% in group A and 13.33% in group B; p= 0.010, The incidence of pain at 24 hour postoperatively is significantly more in group A compared with group B; p= 0.021. Conclusion: We found that harmonic scalpel cholecystectomy is comparable to conventional laparoscopic cholecystectomy in, shortening the time of the procedure and has less sequels and complications in comparison to conventional laparoscopic cholecystectomy. Key Words: Conventional laparoscopic cholecystectomy, harmonic scalpel laparoscopic cholecystectomy, pain, gallbladder perforation and duration of operation.

Gallstone abscess: some drops may end up costlier!

This 47-year-old female patient presented to the Gastrointestinal Surgery OPD at our hospital with long standing abdominal pain and 2 weeks history of fever. She had undergone laparoscopic cholecystectomy 18 months back. CT scan of the abdomen revealed a 4 cm×4 cm well defined extraperitoneal collection located between the left lobe of liver and the anterior abdominal wall compressing the left lobe (Fig. 1). MRI abdomen showed multiple signal void foci in all sequences within the collection (Fig. 2) suggesting the diagnosis of abscess complicating dropped gallstones. Surgical drainage of the abscess with stone retrieval was performed. Intraoperative perforation of the gallbladder and spillage of gallstones is a well-known complication of laparoscopic cholecystectomy, but subsequent abscess formation is unusual [1]. The incidence of gallbladder perforation has been estimated to occur during 15 % to 30 % of laparoscopic cholecystectomy. The incidence of intraabdominal abscesses is reported to be 0.6 % in patients who had bile spillage and 2.9 % in those who had both bile and gallstone spillage [2]. Dropped stones are a potential source of recurrent intraabdominal and intrathoracic abscesses. Hence in addition to drainage of abscess, attempts should be made to remove the calculi either percutaneously or by surgery.

Is harmonic scalpel during laparoscopic cholecystectomy superior than clips and cautery technique?

The standard laparoscopic cholecystectomy is usually performed using a monopolar electrocautery for dissection and clips for occlusion of the cystic duct and cystic artery. Some pitfalls are associated with the use of the monopolar cautery and clips, therefore other alternative techniques have been described. Ultrasonically activated devices have been used for dissection and cystic duct ligation during laparoscopic cholecystectomy (LC) with encouraging results, however it does not gain widespread acceptance among surgeons. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic scalpel to that peiformed by the conventional diathermy and clips. Material and methods: This prospective randomized comparative study included 30 patients (group A) in whom LC was conducted using the conventional method by clipping both the cystic duct and artery with dissection of gallbladder from liver bed by monopolar electrocautery (clips and cautery method = CCM), and 30 patients (group B) who were operated on using laparoscopic harmonic scalpel (LHS) for closure and division of cystic duct and artery and for dissection of gallbladder from liver bed. Our primary end point was the biliary complications; however other intraoperative and postoperative parameters were included: bleeding, duration of operation, postoperative pain, and other complications. Results: Demographic data was similar in both groups. The operative duration was shorter in LHS than CCM (56.3 min vs. 63.3 respectively, p < 0.01), with a significant less incidence of gallbladder peiforation (6.66% vs. 20%, p < 0.001).No postoperative bile leak was encountered in LHS, but it occurred in 3% of patients in CCM No patient developed post operative bleeding in both groups however the amount of postoperative drainage was significantly less in LHS (29 vs. 47.7, p = 0.001). Most of patients were discharged from hospital on 2nd postoperative day; however the delayed discharge was statistically higher in CCM (16.6% vs. 6.66%, p < 0.01). Conclusion: LHS is a reliable, effective and safe tool in LC. It is a good alternative to standard monopolar electrocautery dissection with clipping of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation, and less hospital stay. Abbreviations: CCM= Clip and cautery method, LC= Laparoscopic cholecystectomy, LHS= laparoscopic harmonic scalpel, HFMC= high frequency monopolar cautery, BDI= bile duct injury, CBC= complete blood picture, INR= international normalized ratio, LFT= liver function test, UIS= ultrasonography.

Comparative Study between Clipless Laparoscopic Cholecystectomy by Harmonic Scalpel Versus Conventional Method: A Prospective Randomized Study

BackgroundThis study was planned to compare the traditional method of laparoscopic cholecystectomy (LC) versus LC using harmonic as regard the safety and efficacy. Material and methodsThis study included group A (70 patients) in whom LC was conducted using the traditional method (TM) by clipping both cystic duct and artery and dissection of gallbladder from liver bed by diathermy, and group B (70 patients) LC was conducted using harmonic scalpel (HS) closure and division of both cystic duct and artery and dissection of gallbladder from liver bed by HS. The intraoperative and postoperative parameters were collected including duration of operation, postoperative pain, and complications. ResultsHS provides a shorter operative duration than TM (33.21 + 9.6 vs. 51.7 + 13.79, respectively, p = 0.001), with a significant less incidence of gallbladder peroration (7.1% vs. 18.6, p = 0.04) and less rate of conversion to open cholecystectomy but not reach a statistical significance. The amount of postoperative drainage is significantly less in HS (29 + 30 vs. 47.7 + 31, p = 0.001). No postoperative bile leak was encountered in HS, but it occurred in 2.9% of patients in TM. VAS in HS at 12 h postoperative was 3.25 + 1.84 vs 5.01 + 1.2 (p = 0.001) and at 24 h postoperative was 3.12 + 1.64 vs. 4.48 + 1.89 (p = 0.001). ConclusionHS provides a complete hemobiliary stasis and is a safe alternative to stander clip of cystic duct and artery. It provides a shorter operative duration, less incidence of gallbladder perforation, less postoperative pain, and less rate of conversion to open cholecystectomy.

Percutaneous transhepatic gall bladder drainage: a better initial therapeutic choice for patients with gall bladder perforation in the emergency department

Objectives:To investigate clinical features and outcomes in patients with acute cholecystitis with gall bladder perforation receiving open cholecystectomy or percutaneous transhepatic gall bladder drainage in the emergency department.Methods:From 1996 through...

Hydrodissection with adrenaline–lidocaine–saline solution in laparoscopic cholecystectomy

This investigation examined the effects of a solution injected to the gallbladder bed on operative time, bleeding, incidence of gallbladder perforation, and postoperative pain. One hundred sixty-four consecutive patients with cholelithiasis were randomized into two clinically comparable groups. In group 1 (84 patients), 40 ml of saline-adrenaline-lidocaine solution was injected between the gallbladder and liver. In group 2 (80 patients), laparoscopic cholecystectomy was performed without hydrodissection. The time taken to dissect the gallbladder from the liver, bleeding from the liver bed, incidence of gallbladder perforation and spillage of bile and stones, duration of operation, amount of gas used for the laparoscopic cholecystectomy, conversion to open cholecystectomy, postoperative pain and pain localization were recorded. The mean dissection time, amount of gas used, incidence of gallbladder perforation, spillage of stones, and liver bed bleeding were not significantly different between the groups. There also was no significant difference between the groups regarding postoperative pain and pain localization. Hydrodissection did not reduce time to dissect the gallbladder from the liver or risk of gallbladder perforation. Similarly, adrenaline and lidocaine injection between the gallbladder and the liver did not effect bleeding from the dissection area and did not alter postoperative pain or pain localization.

Current management of gall bladder perforations.

Gall bladder perforation is a serious complication of acute cholecystitis. The purpose of the present study is to evaluate the presenting symptoms, diagnosis and management of patients with gall bladder perforations. A retrospective study was undertaken of 31 consecutive patients with gall bladder perforation in a single unit of a tertiary referral hospital, between January 1996 and December 2001. The incidence of gall bladder perforation was 5.9% of all cases of acute cholecystitis. Associated comorbidity was quite common (58%). Ultrasound and computed tomography scans of the abdomen are sensitive investigations. Ultrasound guided percutaneous drainage helps in tiding over the emergency. The morbidity (35%) and mortality (9.6%) is considerable. The patterns of presentations, diagnosis and management of gall bladder perforation are changing. But there is scope for improvement.

Peritoneal gallstones following laparoscopic cholecystectomy: incidence, complications, and management.

Gallstone spillage during laparoscopic cholecystectomy (LC) is a common intraoperative event. Although gallstones left in the peritoneal cavity were initially considered harmless, a significant number of complications have been reported. Our aim was to quantify the likelihood, and to document the range, of subsequent complications. A Medline search from 1987 to January 2003 was performed. Articles with more than 500 LCs that quantified the frequency of complications due to peritoneal gallstones were reviewed, as were representative case studies of different stated complications. Six studies, covering 18,280 LCs, were found. The incidence of gallbladder perforation was 18.3%, that of gallstone spillage was 7.3%, and that of unretrieved peritoneal gallstones was estimated to be 2.4%. There were 27 patients with complications. The likelihood of a complication when gallstone spillage occurred was 2.3%, which increased to 7.0% when unretrieved peritoneal gallstones were documented. Spilt gallstones have a small but quantifiably real risk of causing a wide range of significant postoperative problems.

The risk of gallbladder perforation at laparoscopic cholecystectomy.

The best policy to prevent the potential hazard of bile and stones spilled at laparoscopic cholecystectomy (LC) is to avoid inadvertent gallbladder (GB) perforations. No study so far has investigated the mechanisms of GB rupture and its predictive risk factors. To address these issues and help define the best strategies to reduce undesirable long-term sequelae, we did a retrospective review of the first 350 consecutive LC performed by a single surgeon at our institution. The clinical and surgical records of our first 350 consecutive LC were reviewed. The significant variables identified on univariate analysis were eventually validated through Spearman's correlation for ordered data and finally correlated to the risk of GB perforation by means of a casewise deletion multiple regression. The equation of the linear regression thus obtained was used to predict the probability of GB perforation by number of risk factors. Three risk factors predictive of GB perforation were identified: chronic cholecystitis with thickened walls >7 mm on preoperative ultrasound (US), GB hydrops (GB > 8 x 4 x 4 cm on US), and previous laparotomies. The incidence of GB perforation rose from a low of 3.5% in the absence of any risk factor to a high of 25% for patients with all three of the independent variables. GB hydrops yielded the highest diagnostic accuracy and probability of perforation (OR = 4.9). Inflammation and a positive history of previous laparotomies play a crucial role in GB perforation at LC. Hydropic GB was the most accurate predictor of rupture. A prospective trial is needed to confirm the data.