Management and outcome of gallbladder perforation during laparoscopic cholecystectomy

ABSTRACT

One of the frequent incidents during laparoscopic cholecystectomy is gallbladder perforation, with subsequent leakage of bile and/or gallstones inside the penitoneal cavity. In this 357 case series, gallbladder perforation occurred in 96 patients [26.9%]. We followed a pre-defined protocol for management of such patients. Stones were retrieved as much as possible, bile was aspirated, the abdominal cavity irrigated until clear, and a closed suction drain was left. There were no late intra-abdominal infectious complications, and no patient required re-operation for intra-abdominal sepsis, abscess formation, intestinal obstruction, or incisionab hernia. Wound sieroma occurred in 2.8% of cases, who were almost evenly distributed in both groups. Prolonged gastrointestinal symptoms were prevalent during the long-term follow up, and included upper abdominal pain [25.2%], flatulence [24.6%], indigestion [12.6%], loose stools [7.8%], and nausea [2.8%]. The incidence of these symptoms was similar in patients with and without gallbladder perforation. The study concluded that inadvertent perforation of the gallbladder during laparoscopic cholecystectomy does not carry the risk of long-term complications, if it is properly managed intra-operatively