Management of iatrogenic gallbladder perforation during laparoscopic cholecystectomy

Abstract

Abstract Purpose Iatrogenic gallbladder perforation frequently occurs during laparoscopic cholecystectomy and may increase the risk of infectious complications. The effectiveness of postoperative antibiotics and drainage in preventing infections remain unclear. The study aimed to investigate the clinical outcomes of patients with Iatrogenic gallbladder perforation during laparoscopic cholecystectomy in relation to these treatments.Methods One hundred twenty-one consecutive patients with Iatrogenic gallbladder perforation during laparoscopic cholecystectomy were enrolled. Surgeons chose the treatments for Iatrogenic gallbladder perforation: antibiotics (n = 48), drainage (n = 39), and no treatment (n = 34). Infectious complications were classified into wound infections, intra-abdominal abscesses, distant infections, and infections with unknown origin.Results The drainage group showed a nonsignificantly higher frequency of overall infectious complications than the other two groups (antibiotics vs. drainage vs. no-treatment = 14.6% vs. 23.1% vs. 11.8%, P = 0.31). The infection-positive group (n = 20) had a higher frequency of diabetes mellitus (positive vs. negative group = 52.6% vs. 17.7%, P = 0.0009) and lower preoperative albumin (3.8 vs. 4.1 g/dL, P = 0.0081) than the infection-negatve group. Multivariate analysis showed that a lower preoperative albumin (OR 4.90, 95% CI 1.20–20.0, P = 0.027) and the presence of diabetes mellitus (OR 5.49, 95% CI 1.62–18.6, P = 0.0063) were independent factors of overall infectious complications.Conclusions Additional treatments such as postoperative antibiotics and drainage may be unnecessary to prevent infectious complications in patients with Iatrogenic gallbladder perforation during laparoscopic cholecystectomy. diabetes mellitus and malnutrition were associated with postoperative infections. These findings should be validated in larger independent samples.