Gallbladder Perforation during Elective Laparoscopic Cholecystectomy: Incidence, Risk Factors, and Short-term Outcomes in Sana'a City, Yemen
Background: Gallbladder perforation (GP), which has been documented to occur with a high incidence after cholecystectomy, is a common intraoperative complication.
The research aimed to determine the incidence, risk factors, and short-term outcomes of gallbladder perforation (GP) after elective laparoscopic cholecystectomy.
Methods: This prospective observational study was conducted at Kuwait University Hospital and 48 Model Hospital in Sana'a, Yemen, from January to December 2022. A structured online questionnaire was used to gather the data. The presence of gallbladder perforation led to the division of patients into two groups. SPSS version 26 was used to analyze incidence, potential risk factors, and short-term outcomes.
Results: This study included 130 cases, with a mean age of 43.42 ± 12.724. Compared to men, women made up the majority of cases (84.6% vs. 15.4%). The GP was noticed in 34 of 130 cases, with a 26.2% incidence rate. Significant risk factors for GP were mean age > 43 years (P = 0.000), obesity (BMI > 30 kg/m2) (P = 0.02), and ASA grades (P = 0.000). Comorbidities, including IHD, HTN, and DM, were associated with an increased incidence of GP (P = 0.05). A significant risk was also linked to previous hospitalizations for acute cholecystitis, elevated alkaline phosphate levels, and leukocytosis (P = 0.009). The presence of adhesions and a difficult dissection as described by the Cuschieri scale (P = 0.02), as well as ultrasound findings of a distended gallbladder, the presence of sludge, and multiple gallbladder stones, were all significantly linked with GP (P = 0.000). Comparing the perforated group to the non-perforated group regarding the short-term outcomes, in the perforated group there was a significant increase in operative time (P = 0.000), length of hospital stay (P = 0.00), duration of post-operative ileus (P = 0.000), and the rate of postoperative complications.
Conclusions: According to this study, the incidence rate of GP was high and comparable to the reported incidence worldwide. Multiple risk factors can influence the GP during elective laparoscopic cholecystectomy. Gallbladder perforation can adversely affect the outcome and increase the complication rate of the operation. Multiple studies performed in different high- and low-volume centers shared similar results about some risk factors for GP but differed in the results of other risk factors, as revealed by our study. This may indicate that the volume of procedures performed is critical for achieving better outcomes in future studies. we believe that additional prospective randomized controlled studies on controllable surgery-related factors and long term outcome can be performed using a complementary study design.