Krishnamurthy Gautham, Ganesan Senthil, Ramas Jayapriya, Damodaran Karthikeyan, Khanna Aswin, Patta Radhakrishna
Department of Surgical Gastroenterology, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India.
Department of Imaging Sciences, SRM Institutes for Medical Science, Chennai, Tamil Nadu, India.
J Minim Access Surg. 2021 Apr-Jun;17(2):153-158. doi: 10.4103/jmas.JMAS_176_19.
Acute gallbladder perforation (GBP) is associated with significant mortality and morbidity. Percutaneous drainage followed by interval cholecystectomy has been the preferred management. The outcomes of early surgery, especially by laparoscopy, have not been well studied in GBP. We present our experience in early laparoscopic cholecystectomy in GBP.
A retrospective analysis of patients admitted with GBP between April 2014 and December 2018 was done. Clinical presentation, preoperative imaging, surgical procedure, operative findings and the outcomes in these patients were analysed. Video of the surgeries was reviewed in case of the absence of data from the case records.
Fifteen patients were treated for GBP during the study period. Eleven patients were male, and the mean age was 61 years. Fourteen patients (93.3%) had associated co-morbidities. Systemic inflammatory response syndrome, sepsis, severe sepsis and septic shock were present in 3, 3, 6 and 3 patients, respectively. The location of the collection was gallbladder fossa, pericholecystic, subhepatic and diffuse in 3, 5, 4 and 3 patients, respectively. Intraoperatively, 13 patients were detected to have perforation at the fundus of the gallbladder. Cystic duct stump was managed with clip, endoloop, suturing and external drainage in 7, 2, 5 and 1 patient, respectively. Laparoscopic cholecystectomy was completed in 12 (80%) patients. Retroinfundibular technique was used in 12 (80%) patients. There was one conversion. Two patients required endoscopic retrograde cholangiogram + bile duct stenting, and one was reexplored for cystic artery bleed. There were no mortalities. The median duration of post-operative hospital stay and drain removal was 3 (1-19) and 3 (1-6), respectively.
Early laparoscopic cholecystectomy in acute GBP is feasible and can be safely performed in centres having sufficient expertise. Retroinfundibular technique of laparoscopic cholecystectomy is useful in tackling frozen Calot's triangle in GBP.
急性胆囊穿孔（GBP）与显著的死亡率和发病率相关。经皮引流后择期行胆囊切除术一直是首选的治疗方法。早期手术，尤其是腹腔镜手术，在GBP中的疗效尚未得到充分研究。我们介绍我们在GBP早期腹腔镜胆囊切除术中的经验。
对2014年4月至2018年12月期间收治的GBP患者进行回顾性分析。分析这些患者的临床表现、术前影像学检查、手术过程、手术发现及结果。若病例记录中无数据，则查看手术视频。
研究期间有15例患者接受了GBP治疗。11例为男性，平均年龄61岁。14例（93.3%）患者伴有合并症。分别有3、3、6和3例患者出现全身炎症反应综合征、脓毒症、严重脓毒症和感染性休克。积液部位分别为胆囊窝、胆囊周围、肝下和弥漫性，各有3、5、4和3例患者。术中，13例患者被检测出胆囊底部穿孔。胆囊管残端分别采用钛夹、圈套器、缝合和外引流处理，各有7、2、5和1例患者。12例（80%）患者完成了腹腔镜胆囊切除术。12例（80%）患者采用了胆囊底部后方技术。有1例中转手术。两名患者需要行内镜逆行胰胆管造影+胆管支架置入术，1例因胆囊动脉出血再次手术探查。无死亡病例。术后住院时间和引流管拔除时间的中位数分别为3（1-19）天和3（1-6）天。
急性GBP早期腹腔镜胆囊切除术是可行的，在有足够专业知识的中心可以安全进行。腹腔镜胆囊切除术的胆囊底部后方技术有助于处理GBP中冰冻的胆囊三角。
