Xanthogranulomatous cholecystitis: A 14‐year experience

Abstract

Aim: Xanthogranulomatous cholecystitis (XGC) is a rare disease. The present study was conducted to evaluate the results of both open cholecystectomy (OC) and laparoscopic cholecystectomy (LC), in patients with XGC. Patients and Methods: A retrospective study was performed including 4228 patients who underwent an OC or LC between January 2003 and November 2017. Sixty-three patients with XGC were identified, and their clinical and operative details were analysed. Results: The incidence of XGC was 1.49 per cent. The mean age of the patients was 65.8 years, and 57 per cent were male. The most common clinical presentation was acute cholecystitis (44.4 per cent). Fortyfive patients (71.4 per cent) underwent an LC, with a conversion rate of 40 per cent. The mean operative times were 127.2 min for OC, 82.2 min for LC and 141.6 min for LC to OC conversion (LOC). The mean operative time was significantly longer for OC compared with LC (P = 0.02). Fifteen patients (23.8 per cent) had some postoperative complications, of which the most frequent was incisional surgical site infection (6.34 per cent). Two patients died (3.2 per cent). The mean postoperative stay was 5.07 days for LC and 11.77 days for OC (P = 0.005). Conclusions: XGC is a rare disease associated with prolonged surgical times, high morbidity and a high LOC rate.

Xanthogranulomatous cholecystitis: diagnostic complexity and review of the literature

“…XGC is characterized by the accumulation of lipid-laden macrophages, termed xanthoma cells, in the intramural lining of the gallbladder wall secondary to the inflammatory response to extravasated bile [ 3 , 4 ]. The disease remains rare, with an estimated incidence of only 1.46% of all cholecystectomy specimens evaluated from a sample of over 12 000, with an observed prevalence of 2:1 males to females [ 4 ].…”

“…These lipid burdened macrophages activate fibroblasts through chemotactic and mitogenic stimulation, and encourage the production of collagen fibres [ 8 , 9 ]. There is resultant hyaline degeneration, formation of intramural nodules and thickening of the gallbladder wall [ 3 , 4 , 10 ]. The resulting erosion may lead to perforation of the gallbladder, peritoneal or hepatic abscess formation, and gastric or bowel fistulae [ 11 ].…”