Accidental Gallbladder Perforation During Laparoscopic Cholecystectomy: Does It Have an Effect on the Clinical Outcomes?

초록

Background: Accidental gallbladder perforation during laparoscopic cholecystectomy (LC) is on the rise because of increased attempts at minimally invasive surgery. There have been a number of studies attempting to determine the influence of gallbladder perforation on the clinical outcomes, but the results are still conflicting. Therefore, we investigated the clinical outcomes and the risk factors in patients who sustained a gallbladder perforation during LC. Methods: We evaluated 198 patients who underwent LC between April 2009 and March 2010. Data were collected from a prospectively maintained database. Results: Thirty-three patients sustained a gallbladder perforation (16.7%) and it primarily occurred during dissection of the hepatic fossa in 21 patients (63.6%). The mean operative time and duration of postoperative hospitalization were longer in the perforated group (P=.015 and P=.001). Visual analog scale scores on the first and second postoperative days were higher in the perforated group (P =.009 and P =.034). Complications such as ileus and trocar site infection developed more frequently in patients with a gallbladder perforation (P =.001 and P=.004). There was no significant factor related to gallbladder perforation except for male gender (P=.017). Conclusion: Accidental gallbladder perforation can cause more postoperative pain, ileus, and trocar site infection, which consequently increases the total duration of hospitalization, undermining the advantages of LC. Based on these interesting results, surgeons should make every effort to prevent gallbladder perforation by performing meticulous dissection during the operation.

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