Iatrogenic gallbladder perforation during laparoscopic cholecystectomy: Etiology and sequelae

Iatrogenic perforation of the gallbladder (PGB) during laparoscopic cholecy stectomy (LC) leads to spillage of bile and gallstones into the peritoneal cavity, which can result in serious postoperative infection. The objective of this study is to prospectively evaluate with long-term follow-up the ris k factors, mechanisms, and complications associated with PGB in patients un dergoing LC. Data from 1412 patients undergoing LC were collected prospecti vely between 1989 and 1995. Patients with and without iatrogenic gallbladde r perforation were compared. Long-term follow-up was obtained using mailed questionnaires and telephone interviews, when needed. Of the 1412 patients, 512 (36%) sustained a PGB. Male sex, weight, gallbladder inflammation, thi ckening of the gallbladder, presence of adhesions, and a difficult hilar di ssection were all associated with an increased incidence of PGB. The most c ommon mechanisms of PCB were laceration due to grasper traction (55%) and e lectrocautery dissection (40%). Both the operating time and length of hospi tal stay were significantly longer in the PGB group. No difference was obse rved in the rate of wound infections between PGB and non-PGB patients (1.6% versus 1.8%). Only one patient (with an inflamed and perforated gallbladde r) developed an early postoperative intra-abdominal abscess. Long-term foll ow-up averaging 48 months was achieved with a response rate of 44 per cent. No late intra-abdominal abscesses or complications attributable to retaine d gallstones were discovered.