The risk of gallbladder perforation at laparoscopic cholecystectomy

Simone, Paolo De; Donadio, R; Urbano, D

doi:10.1007/s004649901181

Cited by 32 publications

(30 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…16 Perforation occurs in 13%-50% of patients who undergo laparoscopic cholecystectomy, and in 10%-40% of these patients, bile leakage and stone spillage are present. 17 Laceration due to grasper traction and electrocautery dissection is the most common mechanism of gallbladder rupture during laparoscopic cholecystectomy.…”

Section: Recherchementioning

confidence: 99%

Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

et al. 2012

View full text Add to dashboard Cite

RESEARCH • RECHERCHEMonopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial Background: Ultrasonic dissection has been suggested as an alternative to monopolar electrocautery in laparoscopic cholecystectomy because it generates less tissue damage and may have a lower incidence of gallbladder perforation. We compared the 2 methods to determine the incidence of gallbladder perforation and its intraoperative consequences. Methods:We conducted a prospective randomized controlled trial between July 2008 and December 2009 involving adult patients with symptomatic gall stone disease who were eligible for laparoscopic cholecystectomy. Patients were randomly assigned before administration of anesthesia to electrocautery or ultrasonic dissection. Both groups were compared for incidence of gallbladder perforation during dissection, bile leak, stones spillage, lens cleaning, duration of surgery and estimation of risk of gallbladder in the presence of complicating factors. Results:We included 60 adult patients in our study. The groups were comparable with respect to demographic characteristics, symptomatology, comorbidities, previous abdominal surgeries, preoperative ultrasonography findings and intraoperative complications. The overall incidence of gallbladder perforation was 28.3% (40.0% in the electrocautery v. 16.7% in the ultrasonic dissection group, p = 0.045). Bile leak occurred in 40.0% of patients in the electrocautery group and 16.7% of patients in ultrasonic group (p = 0.045). Lens cleaning time (p = 0.015) and duration of surgery (p = 0.001) were longer in the electrocautery than the ultrasonic dissection group. There was no statistical difference in stone spillage between the groups (p = 0.62). Conclusion:Ultrasonic dissection is safe and effective, and it improves the operative course of laparoscopic cholecystectomy by reducing the incidence of gallbladder perforation.

show abstract

Section: Recherchementioning

confidence: 99%

Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

et al. 2012

View full text Add to dashboard Cite

show abstract

“…This is consistent with one study 17 and would be in keeping with the assertion that hydrops of the gallbladder is a principal cause of perforation. 25 Calik et al 21 showed no difference in perforation rates. This finding may be due to the inclusion of fewer overfilled gallbladders.…”

Section: Discussionmentioning

confidence: 99%

“…The lack of significant difference may also be confounded by the lack of overfilled gallbladders seen at time of operation. 25 Our summative outcome would suggest that although ASP decreases dissection time, the additional time taken to aspirate the gallbladder may cancel out any advantage gained.…”

Section: Discussionmentioning

confidence: 99%

“…Intuitively, gallbladder perforation gives rise to potentially more bile leakage or gallstone spillage. Given that there is a wealth of literature warning against these events, 9-16 it may still be prudent to consider ASP of the gallbladder in certain circumstances, such as in the elderly, 13 hydropic gallbladders, 25 infected bile, or pigment stones, 31 during the surgeon's learning curve, 5 or circumstances involving those who may have an inherent increased chance of developing infections or abscesses, such as the immunocompromised.…”

Section: Discussionmentioning

confidence: 99%

“…25 As the volume decreases the liver bed may open, making the dissection easier, with theoretically less bleeding. 17 The aforementioned proposals may also decrease operative time.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

A Meta-analysis of Outcomes After Routine Aspiration of the Gallbladder During Cholecystectomy

Siddiqui

Sajid

Nisar

et al. 2011

International Surgery

View full text Add to dashboard Cite

We conducted a meta-analysis of published literature comparing outcomes after aspirating (ASP) the gallbladder versus nonaspiration (NASP). Electronic databases were searched from January 1985 to November 2009. A meta-analysis was performed to obtain a summative outcome. Two randomized, controlled trials involving 360 patients were analyzed. A total of 180 patients were in the ASP group, and 180 were in the NASP group. There was no significant increase in operative time in the ASP group compared with the NASP group [random-effects model: standardized mean difference, 20.72; 95% confidence interval (CI), 22.16, 0.71; z = 0.99; df = 1; P = 0.32], but there was significant heterogeneity among trials (Q = 42.4; P , 0.001; I 2 = 98%). Patients undergoing ASP were less likely to have a gallbladder perforation [random-effects model: risk ratio (RR), 0.42; 95% CI, 0.19, 0.96; z = 2.05; df = 1; P , 0.05], but no difference was found regarding the loss of gallstones (random-effects model: RR, 1.33; 95% CI, 0.30, 5.85; z = 0.38; df = 1; P = 0.70). No difference was seen for liver bed bleeding (P = 0.43) or overall 30-day infection rates (P = 0.66). After aspiration, gallbladder perforation rates may be lower. This does not appear to translate into decreased loss of gallstones or infection rates. There was no significant difference between techniques in blood loss from the liver bed. Further randomized, controlled trials and follow-up studies are required to confirm these results and to establish long-term sequelae.

show abstract

Randomized clinical trial of ultrasonicversuselectrocautery dissection of the gallbladder in laparoscopic cholecystectomy

Janssen

Swank

Boonstra

et al. 2003

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

The risk of gallbladder perforation at laparoscopic cholecystectomy

Abstract: 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.

Cited by 32 publications

References 10 publications

Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

Monopolar electrocautery versus ultrasonic dissection of the gallbladder from the gallbladder bed in laparoscopic cholecystectomy: a randomized controlled trial

A Meta-analysis of Outcomes After Routine Aspiration of the Gallbladder During Cholecystectomy

Randomized clinical trial of ultrasonicversuselectrocautery dissection of the gallbladder in laparoscopic cholecystectomy

Contact Info

Product

Resources

About