Gallbladder perforation during laparoscopic cholecystectomy

A matched-cohort analytic study was performed to assess the influence an po stoperative morbidity and on long-term outcome of gall-bladder perforation (GP) during laparoscopic cholecystectomy (LC) and to determine the existenc e of risk factors of GP. A total of 1127 consecutive patients who underwent successful LC were included. AII patients received a preoperative dose of intravenous antibiotic. If GP occurred, free bile was aspirated, the abdomi nal cavity was irrigated, spined stones were retrieved whenever possible, a nd antibiotic treatment was prolonged. Intraoperative GP occurred in 131 ca ses (11.6%). The Cox multivariate proportional hazards model showed that th e surgeon's experience was the only factor associated with a higher risk of GP (p < 0.0001). Patients who had GP were retrospectively matched with 131 patients who did not have perforation. Statistical differences between the two matched groups were found for the median length of surgery 74 minutes in the GP group versus 61 minutes, p < 0.01). No differences were found far (1) postoperative complications and reoperations (3.8% in GP group vs. 6.1 % and 0% in GP group vs. 0.8%, respectively); or (2) mean postoperative hos pital stay (2.9 +/- 2.3 days in GP group vs. 2.6 +/- 1.6 days). No late con sequences occurred that could be attributed to intraoperative GP. The resul ts suggest that the frequency of GP during LC tends to diminish as the surg eon gains experience,vith this type of surgery. This event does not cause c omplications if adequate prophylactic antibiotic therapy is administered; s pilled stones are retrieved whenever possible, and the abdominal cavity is abundantly irrigated.