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Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible?

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Abstract

Background

Xanthogranulomatous cholecystitis is an inflammatory disease with pathologically distinct characteristics such as accumulation of lipid-laden macrophages, fibrous tissue, and acute and chronic inflammatory cells. It often involves adjacent organs and mimics gallbladder cancer. The purpose of this study was to review the clinical findings of xanthogranulomatous cholecystitis and to determine the appropriate treatment plan.

Methods

We retrospectively analyzed clinical demographics, operation records, and postoperative results of 31 patients with a pathological diagnosis of xanthogranulomatous cholecystitis who underwent surgery between January 2010 and 2015 at two university hospitals.

Results

Xanthogranulomatous cholecystitis was found in 0.81% (31/3820) of cholecystectomy patients in our hospital over 5 years. The most frequently observed clinical symptom was abdominal pain (21 patients, 67.7%). Preoperative radiological studies showed cholelithiasis in 23 patients (74.2%), thickening of the gallbladder wall in 23 patients (74.2%), and suspicious cancer in 2 patients (6.5%), but there were no cases of gallbladder cancer accompanying xanthogranulomatous cholecystitis. Laparoscopic cholecystectomy was planned in all patients and was converted to open cholecystectomy in five patients. T-tube choledocholithotomy was needed in one patient due to common bile duct injury. Mean operation time was 149.2 min, and estimated blood loss was 270.1 mL. There were two patients with complications greater than Clavien–Dindo Classification grade III (CBD injury, pleural effusion).

Conclusion

An initial laparoscopic approach is possible for xanthogranulomatous cholecystitis. However, it is troublesome and challenging, with significantly higher conversion and complication rates compared to standard laparoscopic cholecystectomy.

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Acknowledgement

This study did not involve any funding bodies.

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Authors and Affiliations

  1. Department of Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, South Korea

    Jae Woo Park, Say-June Kim & Sang Kuon Lee

  2. Department of Surgery, Uijeongbu St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, South Korea

    Kee-Hwan Kim

Authors
  1. Jae Woo Park
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  2. Kee-Hwan Kim
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  4. Sang Kuon Lee
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Contributions

SKL designed the study and offered final approval on the version for publication. SJK and KHK contributed to data acquisition and analysis. JWP conducted data analysis and wrote the paper. All authors read and approved the final manuscript. JWP and KHK contributed equally to this article.

Corresponding author

Correspondence to Sang Kuon Lee.

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Disclosures

Jae Woo Park, Kee-Hwan Kim, Say-June Kim, and Sang Kuon Lee have no conflicts of interest or financial ties to disclose.

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Park, J.W., Kim, KH., Kim, SJ. et al. Xanthogranulomatous cholecystitis: Is an initial laparoscopic approach feasible?. Surg Endosc 31, 5289–5294 (2017). https://doi.org/10.1007/s00464-017-5604-z

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  • DOI: https://doi.org/10.1007/s00464-017-5604-z

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