Is xanthogranulomatous cholecystitis the most difficult for laparoscopic cholecystectomy?
OBJECTIVE
Xanthogranulomatous cholecystitis (XGC) is a rare disease of the gallbladder, showing high conversion rate and complications. However, it has been reported as collected data or as a case review. Therefore, we compared surgical outcomes of laparoscopic cholecystectomy (LC) in patients who were diagnosed with XGC with that of other cholecystitis.


METHODS
From November 2001 to March 2008, 3209 cholecystectomies were performed at Ajou University Medical Center. Twenty-three patients (0.7%) were histopathologically diagnosed with XGC. Of 23 patients, we retrospectively analyzed the data of 15 patients who underwent initial laparoscopic approach for XGC and compared the data with those of severe acute and non-severe cholecystitis (SAC and NSC).


RESULTS
The conversion rate was 40% (6/15) and mean operative time was 101.6+/-47.1 min. In the XGC group, conversion rate was significantly higher than in the other cholecystitis groups, even more than that for severe acute cholecystitis (SAC) (P<0.05). In addition, the rate of coexistence of gallbladder cancer (13.3%) was significantly higher in the XGC group than in the SAC group (P<0.05). Whereas, there were no statistical differences in the operative time and postoperative stay between XGC and SAC. Postoperative complications were present in 2 patients, including colonic fistula and major bile duct injury, however it was not significantly different between the three groups (P>0.05).


CONCLUSIONS
XGC is association with a high conversion rate and a high coexistence of gallbladder cancer, compared even with SAC. Therefore, a careful preoperative evaluation for differentiation between XGC and gallbladder cancer is needed. First of all, proper intraoperative decision making such as whether the frozen-section biopsy and/or conversion to open cholecystectomy should be performed is important.
Kim
Ji Hun
JH
Department of Surgery, School of Medicine, Ajou University, Suwon, Korea.
Jeong
In Ho
IH
Yoo
Byung Moo
BM
Kim
Jin Hong
JH
Kim
Myung Wook
MW
Kim
Wook Hwan
WH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects; D002764:Cholecystitis / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006099:Granuloma / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014973:Xanthomatosis / Q000473:pathology / Q000601:surgery*; D055815:Young Adult