Laparoscopic cholecystectomy for xanthogranulomatous cholecystitis: 18 years of experience

Abstract

Background Xanthogranulomatous cholecystitis (XG) is a rare inflammatory disease of the gallbladder (GB), macroscopic appearance may be confused with gallbladder cancer (GC) making the diagnosis challenging. Laparoscopic cholecystectomy (LC) is considerate the gold standard for the management of benign gallbladder disease however LC in XGC is associated with a high conversion rate to open cholecystectomy with a rate of 10.6 to 80%. The aim of this study was to determinate the rate of laparoscopic cholecystectomy on patients with histopathological diagnosis of CXG and the associated morbidity to the procedure. Material and methods This study is an observational, retrospective, and cross-sectional study carried out over a period of 18 years in a single institution. Patients underwent to laparoscopic cholecystectomy with histopathological diagnosis of xanthogranulomatous cholecystitis were included. The primary outcome was the rate of conversion to open surgery; secondary outcomes were the morbidity and mortality. The data were reported on percentages and averages. Statistical Package for the Social Sciences (SPSS, version 26) was used to analyze the data. The study was approved by the board of ethical committee in our institution in 2018. Results We registered 142 patients operated from cholecystectomy with histopathologic results of XGC and 106 surgeries were performed laparoscopically (74.6%); 52 were emergency surgeries (49%) and 54 elective (51%). The conversion rate to open cholecystectomy was 3.7% (4 patients). There were 5 post-surgical complications (4.7%) one biloma, one surgical site infection, and 3 pancreatitis. Conclusions XGX represents a surgical challenge from diagnosis to surgical management and is associated to a higher number of perioperative complications; nevertheless, a laparoscopic approach is safe in high volume centers with experience in laparoscopy.