Gall Bladder Empyema Treated by Laparoscopic Cholecystectomy

Abstract

ABSTRACT
Background: Empyema of gallbladder is a sequel of severe acute cholecystitis in which
the gallbladder is filled with pus. Previously, laparoscopic cholecystectomy was
contraindicated in such cases because of fear of fatal complications.
Objectives: To determine the safety of laparoscopic cholecystectomy in empyema of
gallbladder management.
Methods: Cross-sectional retrospective study conducted on 92 patients with empyema of
gallbladder who underwent laparoscopic cholecystectomy at Al-Yarmouk teaching
hospital, and two private hospitals in Baghdad, Iraq. The procedure was performed by four
-port technique.
Results: From Jan 2002 to May 2014, a retrospective study of 92 case of gallbladder
empyema, laparoscopic cholecystectomy was performed for 92 cases proved to have
empyema of gallbladder. A successful laparoscopic cholecystectomy done to 75 cases
(81.52%) (Group I), while conversion to open cholecystectomy done to17 (18.47%)
(Group II ) patients due to various reasons, as a gangrenous gallbladder wall 6 (6.5%)
patients, cystic artery bleeding 5 (5.4%) patients, severe adhesion and obscured anatomy
of Calot’s triangle 3 (3.2%) patients. Duodenal perforation 2 patients (2.1%) patients and
common bile duct injury 1 (1.08%) patient. Maximum operative time was 90 minute (4
cases). Postoperative complications occurred in 22(29.3%) patients of Group I, and
9(52.9%) patients of Group II. Group I (75 patients) in whom successively laparoscopic
cholecystectomy (LC) was done, and Group II (17 patients) where conversion to open
cholecystectomy done. About (70.6%) of Group I patients discharged from hospital within
1-3days, and about (52.9%) of Group II patients discharged from hospital within 7days.
Conclusion: Empyema of gallbladder is a serious form of acute cholecystitis, where the
laparoscopic cholecystectomy can be done to manage it safely. However, the experience
of the surgeon plays a main role in the outcome.