| The risk of gallbladder perforation at laparoscopic cholecystectomy. | |
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MedLine Citation:
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PMID: 10556446 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The best policy to prevent the potential hazard of bile and stones spilled at laparoscopic cholecystectomy (LC) is to avoid inadvertent gallbladder (GB) perforations. No study so far has investigated the mechanisms of GB rupture and its predictive risk factors. To address these issues and help define the best strategies to reduce undesirable long-term sequelae, we did a retrospective review of the first 350 consecutive LC performed by a single surgeon at our institution. METHODS: The clinical and surgical records of our first 350 consecutive LC were reviewed. The significant variables identified on univariate analysis were eventually validated through Spearman's correlation for ordered data and finally correlated to the risk of GB perforation by means of a casewise deletion multiple regression. The equation of the linear regression thus obtained was used to predict the probability of GB perforation by number of risk factors. RESULTS: Three risk factors predictive of GB perforation were identified: chronic cholecystitis with thickened walls >7 mm on preoperative ultrasound (US), GB hydrops (GB > 8 x 4 x 4 cm on US), and previous laparotomies. The incidence of GB perforation rose from a low of 3.5% in the absence of any risk factor to a high of 25% for patients with all three of the independent variables. GB hydrops yielded the highest diagnostic accuracy and probability of perforation (OR = 4.9). CONCLUSIONS: 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. |
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Authors:
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P De Simone; R Donadio; D Urbano |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Surgical endoscopy Volume: 13 ISSN: 0930-2794 ISO Abbreviation: Surg Endosc Publication Date: 1999 Nov |
Date Detail:
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Created Date: 1999-12-03 Completed Date: 1999-12-03 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8806653 Medline TA: Surg Endosc Country: GERMANY |
Other Details:
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Languages: eng Pagination: 1099-102 Citation Subset: IM |
Affiliation:
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II Clinica Chirurgica, Università di Roma La Sapienza, Policlinico Umberto I, Viale del Policlinico 155, 00161, Rome, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Cholecystectomy, Laparoscopic* / methods Cholecystitis / surgery Female Gallbladder / injuries* Humans Intraoperative Complications / epidemiology* Male Middle Aged Risk Factors |
| Comments/Corrections | |
Comment In:
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Surg Endosc. 2000 Nov;14(11):1087-8
[PMID:
11116427
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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