Floryn Cherbanyk1, Maria Dimitrief1, Hon Lai Chan1, A. Stanescu2, Petra Rosskopfova1, Alexis Litchinko1, Olivier Martinet1, Daniel Roulet1, Edgardo Pezzetta1. 1Department of General Surgery, Riviera-Chablais Hospital, 1820 Montreux-Switzerland, 2Department of General Surgery, HFR Fribourg, 1700 Switzerland
Introduction: Even if nowadays is considered a routine, standardized and well mastered procedure, laparoscopic cholecystectomy may become a difficult challenge in patients presenting xanthogranulomatous cholecystitis (XGC). XGC is a rare variant of cholecystitis (3%, higher incidence in Indian patients), with a rate of coexisting carcinoma ranging from 2 to 13%. Pre-operative symptoms and signs are non-characteristic and the radiological findings specific for XGC or discriminative between XGC and carcinoma are infrequently mentioned. In most of the cases, the diagnosis is histopathological. The laparoscopic management of the XGC has an important conversion rate (30-60%) and a higher postoperative complication percentage.
Methods: We report 3 cases of patients presenting with XGC: 1 male, 2 females, aged respectively 78, 44 and 78 years. Clinical presentation and blood test were specific for acute cholecystitis.
We performed laparoscopic cholecystectomies, which proved to be laborious with a difficult identification of the anatomic landmarks. Intraoperative cholangiography was necessary in 1 case. Operative was time sensibly longer than a routine cholecystectomy for acute cholecystitis.
Results: No conversion to open surgery was necessary and the length of hospital stay was between 2 and 5 days. No postoperative morbidity was recorded. Histopathological examination confirmed XGC in the 3 cases ruling definitively out gallbladder cancer.
Conclusion: Difficult identification and dissection of the anatomical landmarks, prolonged operative time are common features of laparoscopic cholecystectomy for XGC. The final diagnosis is histopathological; an intraoperative frozen section would be suitable in order to eventually identify a gallbladder neoplasia. The laparoscopic cholecystectomy for XGC is feasible, safe, but challenging.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80156
Program Number: P143
Presentation Session: Poster (Non CME)
Presentation Type: Poster
