The safety of laparoscopic surgery in treatment of empyema gall bladder

Abstract

Background: Empyema Gallbladder is a sequel of severe acute cholecystitis.   Previously, laparoscopic cholecystectomy   was relatively contraindicated because of fatal complications.  Objectives: To determine the safety of laparoscopic surgery in treatment of empyema gallbladder. Methods: A retrospective study conducted on 92 patients from Nov. 2007 to May 2017, with gallbladder empyema who underwent laparoscopic cholecystectomy at Al-Yarmouk teaching hospital in Baghdad, Iraq. The operation was done by using four ports. Results: A retrospective study of 92 case of empyema gallbladder, laparoscopic cholecystectomy was performed for 92 cases proved to have empyema gallbladder. A successful laparoscopic cholecystectomy done to 75 cases (81.52%) (Group I), a conversion to open cholecystectomy was done to17 (18.47%) (Group II) patients due to various reasons, the most common as a gangrenous wall of gallbladder 6 (6.5%) patients, bleeding from cystic artery 5 (5.4%) patients, severe obscured anatomy of Calot’s triangle duo to adhesions 3 (3.2%) patients. Duodenal injury 2 (2.1%) patients and common bile duct injury 1 (1.08%) patient. Maximum operative time was 80 minutes for all cases. Postoperative complications occurred in 22(29.3%) patients of Group I, and 9(52.9%) patients of Group II. Group I (75 patients) in whom successively laparoscopic cholecystectomy (LC) was done, and Group II (17 patients) where conversion to open cholecystectomy. About 53(70.6%) of Group I patients discharged from hospital within 1-3days, and about 9 (52.9%) of Group II patients discharged from hospital within 7days. Conclusions: Gallbladder Empyema is a serious   sequel of acute cholecystitis, where the laparoscopic cholecystectomy can be done to treat it safely.