Intraoperative Gallbladder Perforation During LaparoscopicCholecystectomy: Incidence, Risk Factors, and Postoperative Outcomesin a Tertiary Care Hospital

Abstract

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic cholelithiasis. Intraoperative
gallbladder perforation (IGP) is a frequent but often under-reported complication, with reported incidences ranging from 10% to
40% in international series [1,2]. The clinical implications of IGP, particularly regarding surgical site infection (SSI) and length of
hospital stay (LOS), remain a subject of debate. This study aimed to determine the incidence, identify risk factors, and evaluate the
postoperative outcomes of IGP during LC in a tertiary care setting in Bangladesh.
Methods: This prospective observational study was conducted in the Department of Surgery at Kurmitola General Hospital, Dhaka,
Bangladesh, from November 2020 to March 2021. A total of 100 patients with symptomatic cholelithiasis undergoing elective LC
were enrolled. Patients were categorized into two groups based on the occurrence of IGP: the perforation group and the noperforation group. Preoperative demographic data, ultrasonographic findings, intraoperative details, and postoperative outcomes
(pain, pyrexia, SSI, and LOS) were recorded and analyzed.
Results: The incidence of IGP was 19.0% (19/100). Female patients constituted the majority in both groups (73.7% in the
perforation group vs. 69.1% in the no-perforation group). The most common site of perforation was during dissection of the
gallbladder from the liver bed (52.6%), followed by grasper traction (36.9%). Patients in the perforation group experienced a
significantly longer mean hospital stay (5.9 ± 1.3 days vs. 4.2 ± 1.1 days; p<0.05) and a higher incidence of persistent postoperative
pain (>6 days) (26.3% vs. 9.9%). The overall rate of surgical site infection (SSI) was low and comparable between groups (10.5%
vs. 6.2%).
Conclusion: IGP during LC is a common intraoperative event with an incidence of 19.0% in our setting. While it does not appear
to significantly increase the risk of major infectious complications, it is associated with increased postoperative pain and a longer
hospital stay. These findings underscore the need for meticulous surgical technique and awareness of this complication to optimize
patient recovery.