title: Pre- and intraoperative evaluation of biliary system for successful laparoscopic cholecystectomy in porcelain gallbladder patients.
abstract: OBJECTIVE
  A porcelain gallbladder is generally thought to be a relative contraindication for laparoscopic cholecystectomy because of the difficulties in grasping the calcified wall of the gallbladder with forceps and making a retraction which would create a good operation field. The aim of this study was to define the clinical criteria for safe laparoscopic cholecystectomy in the treatment of porcelain gallbladders.
  
  
  METHODS
  Between January 1993 and December 2000, 4 patients with porcelain gallbladders underwent laparoscopic cholecystectomy in our department. The significant features of the biliary system which contributed to the surgical results were investigated in these patients.
  
  
  RESULTS
  All 4 patients were successfully treated by means of laparoscopic cholecystectomy. The confluence of the cystic duct was clearly demonstrated on the preoperative cholangiogram in all patients. Furthermore, the neck portion of the gallbladder wall, revealed no calcification on the CT scans of 3 patients, although the whole wall of the gallbladder, including the neck portion, showed a circumferential calcification in the remaining patient. Laparoscopic exposure and dissection of the Calot's triangle was relatively easy to perform in the former and was difficult in the latter, and thus, an anterograde laparoscopic cholecystectomy was the procedure of choice. Intraoperative cholangiography clearly demonstrated the confluence of the cystic duct in all of the patients.
  
  
  CONCLUSIONS
  Porcelain gallbladder is an indication for laparoscopic cholecystectomy, especially in cases of a patent cystic duct and an uncalcified wall in the neck portion of the gallbladder. Laparoscopic cholecystectomy might be an indication for selected patients with porcelain gallbladder when an uncalcified and patent cystic duct are evident in pre- and intraoperative cholangiograms.
authors.affiliation: Department of Surgery II, Nagasaki University School of Medicine, Nagasaki, Japan. tkuroki-gi@umin.ac.jp
authors.forename: Tamotsu
authors.initials: T
authors.lastname: Kuroki
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Tajima
authors.forename: Sumihiro
authors.initials: S
authors.lastname: Matsuzaki
authors.forename: Kenzo
authors.initials: K
authors.lastname: Fukuda
authors.forename: Tomoo
authors.initials: T
authors.lastname: Kitajima
authors.forename: Junichiro
authors.initials: J
authors.lastname: Furui
authors.forename: Takashi
authors.initials: T
authors.lastname: Kanematsu
mesh_terms: D000368:Aged; D002114:Calcinosis / Q000601:surgery; D017081:Cholecystectomy, Laparoscopic; D002765:Cholecystography; D000075202:Contraindications; D005260:Female; D005704:Gallbladder / Q000473:pathology*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed