Minimally invasive approach in a rare emergency surgery, gallbladder perforation.
Conversion to open cholecystectomy
Gallbladder perforation
Laparoscopy
Minimally invasive surgery
Modified Niemeier type I
Journal
BMC surgery
ISSN: 1471-2482
Titre abrégé: BMC Surg
Pays: England
ID NLM: 100968567
Informations de publication
Date de publication:
10 Jul 2024
10 Jul 2024
Historique:
received:
20
01
2024
accepted:
01
07
2024
medline:
11
7
2024
pubmed:
11
7
2024
entrez:
10
7
2024
Statut:
epublish
Résumé
Gallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification. Patients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups. This study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55-85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60-225]) and COC (125.0 min [110-180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34-63]) and COC (55 years [36-59]) groups (p = 0.001). LC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot's triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations.
Sections du résumé
BACKGROUND
BACKGROUND
Gallbladder perforations are challenging to manage for surgeons due to their high morbidity and mortality, rarity, and surgical approach. Laparoscopic cholecystectomy (LC) is now included with open cholecystectomy in surgical managing gallbladder perforations. This study aimed to evaluate the factors affecting conversion from laparoscopic to open cholecystectomy in cases of type I gallbladder perforation according to the Modified Niemeier classification.
METHODS
METHODS
Patients who met the inclusion criteria were divided into two groups: LC and conversion to open cholecystectomy (COC). Demographic, clinical, radiologic, intraoperative, and postoperative factors were compared between groups.
RESULTS
RESULTS
This study included 42 patients who met the inclusion criteria, of which 28 were in the LC group and 14 were in the COC group. Their median age was 68 (55-85) years. Age did not differ significantly between groups (p = 0.218). However, the sex distribution did differ significantly between groups (p = 0.025). The location of the perforation differed significantly between groups (p < 0.001). In the LC group, 22 patients were perforated from the fundus, four from the trunk, and two from the neck. In the COC group, two patients were perforated from the fundus, four from the trunk, and eight from the neck. Surgical procedure times differed significantly between the LC (105.0 min [60-225]) and COC (125.0 min [110-180]) groups (p = 0.035). The age of the primary surgeons also differed significantly between the LC (42 years [34-63]) and COC (55 years [36-59]) groups (p = 0.001).
CONCLUSIONS
CONCLUSIONS
LC can be safely performed for modified Niemeier type I gallbladder perforations. The proximity of the perforation site to Calot's triangle, Charlson comorbidity index (CCI), and Tokyo classification are factors affecting conversion from laparoscopic to open surgery of gallbladder perforations.
Identifiants
pubmed: 38987756
doi: 10.1186/s12893-024-02495-z
pii: 10.1186/s12893-024-02495-z
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
207Informations de copyright
© 2024. The Author(s).
Références
Zhang XD, Wang XX, Xiong J, Liu MZ. Clinical experience in laparoscopic treatment of gallbladder perforation. J Minim Access Surg. 2023;19(1):80–4.
doi: 10.4103/jmas.jmas_227_21
pubmed: 36722533
pmcid: 10034809
Warsinggih M, Arsyad A, Faruk M. Gallbladder perforation: a rare case report. Int J Surg Case Rep. 2023;104:107927.
doi: 10.1016/j.ijscr.2023.107927
pubmed: 36791527
pmcid: 9950929
Patel G, Jain A, Kumar RB, Singh N, Karim T, Mishra R. Gallbladder perforation: a prospective study of its divergent appearance and management. Euroasian J Hepatogastroenterol. 2019;9(1):14–9.
pubmed: 31988861
pmcid: 6969324
Niemeier OW. Acute free perforation of the gall-bladder. Ann Surg. 1934;99(6):922–4.
doi: 10.1097/00000658-193499060-00005
pubmed: 17867204
pmcid: 1390061
Fletcher AG Jr. Perforation of the gallbladder. Am J Surg. 1951;81(2):178–85.
doi: 10.1016/0002-9610(51)90209-7
pubmed: 14819452
Angeles-Mar HJ, Elizondo-Omaña RE, Guzmán-López S, Quiroga-Garza A. Early laparoscopic cholecystectomy in acute gallbladder perforation - single-centre experience. J Minim Access Surg. 2022;18(2):324–5.
doi: 10.4103/jmas.JMAS_211_21
pubmed: 35046163
Ausania F, Guzman Suarez S, Alvarez Garcia H, Senra del Rio P. Casal Nuñez E. Gallbladder perforation: morbidity, mortality and preoperative risk prediction. Surg Endosc. 2015;29(4):955–60.
doi: 10.1007/s00464-014-3765-6
pubmed: 25159627
Huang SF, Han YH, Chen J, Zhang J, Huang H. Surgical management of cholecystoenteric fistula in patients with and without gallstone ileus: an experience of 29 cases. Front Surg. 2022;9:950292.
doi: 10.3389/fsurg.2022.950292
pubmed: 35874133
pmcid: 9304664
Gonzalez-Urquijo M, Rodarte-Shade M, Lozano-Balderas G, Gil-Galindo G. Cholecystoenteric fistula with and without gallstone ileus: a case series. Hepatobiliary Pancreat Dis Int. 2020;19(1):36–40.
doi: 10.1016/j.hbpd.2019.12.004
pubmed: 31919039
Liu YY, Bi SY, He QR, Fan Y, Wu SD. Developments in the diagnosis and management of cholecystoenteric fistula. J Invest Surg. 2022;35(11–12):1841–6.
doi: 10.1080/08941939.2022.2113188
pubmed: 36167340
Krishnamurthy G, Ganesan S, Ramas J, Damodaran K, Khanna A, Patta R. Early laparoscopic cholecystectomy in acute gallbladder perforation: single-centre experience. J Minim Access Surg. 2021;17(2):153–8.
doi: 10.4103/jmas.JMAS_176_19
pubmed: 33723178
Xiao Y, Salem R, Maula S, Belanger C, Tiesenga F. Spontaneous gallbladder perforation: a case report. Cureus. 2022;14(12):e32249.
pubmed: 36620797
pmcid: 9814229
Gupta V, Chandra A, Gupta V, Patel R, Dangi A, Pai A. Gallbladder perforation: a single-center experience in north India and a step-up approach for management. Hepatobiliary Pancreat Dis Int. 2022;21(2):168–74.
doi: 10.1016/j.hbpd.2021.08.011
pubmed: 34548226
von Elm E, Altman DG, Egger M, et al. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806–8.
doi: 10.1136/bmj.39335.541782.AD
Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson comorbidity index: a critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8–35.
doi: 10.1159/000521288
pubmed: 34991091
Yokoe M, Hata J, Takada T, et al. Tokyo guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41–54.
doi: 10.1002/jhbp.515
pubmed: 29032636
Nassar AHM, Hodson J, Ng HJ, et al. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system [published correction appears in Surg Endosc. 2023;37(3):2415]. Surg Endosc. 2020;34(10):4549–61.
Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96.
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
Basukala S, Rijal S, Karki S, Basukala B, Gautam AR. Spontaneous gallbladder perforation in patient with COVID-19-a case report and review of literature. J Surg Case Rep. 2021;2021(11):rjab496.
doi: 10.1093/jscr/rjab496
pubmed: 34804482
pmcid: 8598116
Sahbaz NA, Peker KD, Kabuli HA, Gumusoglu AY, Alis H. Single center experience in laparoscopic treatment of gallbladder perforation. Wideochir Inne Tech Maloinwazyjne. 2017;12(4):372–7.
pubmed: 29362652
pmcid: 5776488
Rajput D, Gupta A, Kumar S, Singla T, Srikanth K, Chennatt J. Clinical spectrum and management outcome in gallbladder perforation-a sinister entity: retrospective study from sub-himalayan region of India. Turk J Surg. 2022;38(1):25–35.
doi: 10.47717/turkjsurg.2022.5325
pubmed: 35873750
pmcid: 9278357
Kumar A, Shah NP, Pandit N, Sah SP, Gupta RK, Shah R. Non-malignant gall bladder perforation: our experience from an institution-based retrospective analysis of 25 cases. Trop Doct. 2022;52(1):34–7.
doi: 10.1177/00494755211036593
pubmed: 34369824
Stefanidis D, Sirinek KR, Bingener J. Gallbladder perforation: risk factors and outcome. J Surg Res. 2006;131(2):204–8.
doi: 10.1016/j.jss.2005.11.580
pubmed: 16412466
Ramírez-Giraldo C, Isaza-Restrepo A, Conde Monroy D, Castillo-Barbosa AC, Rubio-Avilez JJ, Van-Londoño I. What is the best score for predicting difficult laparoscopic cholecystectomy? A diagnostic trial study. Int J Surg. 2023;109(7):1871–9.
pubmed: 37288543
pmcid: 10389651
Agrawal N, Singh S, Khichy S. Preoperative prediction of difficult laparoscopic cholecystectomy: a scoring method. Niger J Surg. 2015;21(2):130–3.
doi: 10.4103/1117-6806.162567
pubmed: 26425067
pmcid: 4566319
Siddiqui MA, Rizvi SAA, Sartaj S, Ahmad I, Rizvi SWA. A standardized ultrasound scoring system for preoperative prediction of difficult laparoscopic cholecystectomy. J Med Ultrasound. 2017;25(4):227–31.
doi: 10.1016/j.jmu.2017.09.001
pubmed: 30065497
pmcid: 6029324
Tongyoo A, Liwattanakun A, Sriussadaporn E, Limpavitayaporn P, Mingmalairak C. The modification of a preoperative scoring system to predict difficult elective laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2023;33(3):269–75.
doi: 10.1089/lap.2022.0407
pubmed: 36445743
pmcid: 9997034
Carrizo SP, Magris JM, Da Rosa JL, Garcias LM, Gramatica L. Utilidad Del score de la Colecistectomía Dificultosa según conversión laparoscópica [Usefulness of the difficult cholecystectomy score according to laparoscopic conversion]. Rev Fac Cien Med Univ Nac Cordoba. 2020;77(4):307–11.
doi: 10.31053/1853.0605.v77.n4.28903
pubmed: 33351374
Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997;21(6):629–33.
doi: 10.1007/PL00012288
pubmed: 9230661
Ackermann J, Baumann J, Pape J, Pahls J, Ruchay Z, Spüntrup C, et al. Factors influencing surgical performance and learning progress in minimally invasive surgery - results of an interdisciplinary multicenter study. Int J Surg. 2023;109(10):2975–86.
doi: 10.1097/JS9.0000000000000590
pubmed: 37462985
pmcid: 10583955
Salkini MW, Hamilton AJ. The effect of age on acquiring laparoscopic skills. J Endourol. 2010;24(3):377–9.
doi: 10.1089/end.2009.0155
pubmed: 19839781
Leitzke FB, Teivelis MP, Matos LL, Wolosker N, Szor DJ. Evaluation of laparoscopic skills in medical students. Einstein (Sao Paulo). 2022;20:eAO0091.
doi: 10.31744/einstein_journal/2022AO0091
pubmed: 36449757
Sabour AF, Matsushima K, Love BE, et al. Nationwide trends in the use of subtotal cholecystectomy for acute cholecystitis. Surgery. 2020;167(3):569–74.
doi: 10.1016/j.surg.2019.11.004
pubmed: 31879089
Ramírez-Giraldo C, Van-Londoño I, Re. The modification of a preoperative scoring system to predict difficult elective laparoscopic cholecystectomy by Tongyoo, et al. J Laparoendosc Adv Surg Tech A. 2023;33(6):523.
doi: 10.1089/lap.2023.0003
pubmed: 36791319
Lee JM, Kang JS, Choi YJ, et al. Suggested use of empirical antibiotics in acute cholecystitis based on bile microbiology and antibiotic susceptibility. HPB (Oxford). 2023;25(5):568–76.
doi: 10.1016/j.hpb.2023.01.017
pubmed: 36804057