Surgical procedures and histopathologic findings for patients with xanthogranulomatous cholecystitis1

Abstract

Xanthogranulomatous cholecystitis (XGC) is an unusual and destructive inflammatory process of the gallbladder. Laparoscopic cholecystectomy (LC) may be contraindicated in XGC because of a high incidence of complications and coexistent malignancy. In this study, we examined the management of LC in patients with XGC. LC was attempted on 1,408 consecutive patients, including 27 (1.9%) patients with histopathologically diagnosed XGC. All patients underwent preoperative spiral computed tomography after IV infusion cholangiography and intraoperative cholangiography. We examined the correlation between the inflammatory grade of XGC and the difficulty of LC. LC was completed in 22 (81%) of the 27 patients diagnosed with XGC. Two patients with common bile duct injuries (partial lacerations) were confirmed by laparoscopic cholangiography, and injuries were simply closed using a laparoscopic technique. An intraoperative frozen-section examination revealed gallbladder carcinomas in two patients, and additional hepatectomies were performed in these patients after LC. Five patients (19%) with XGC required open operation. All of the laparoscopic failures were attributable to dense fibrotic adhesions in Calot’s triangle and in the surrounding tissues. Histopathologically, nine patients had a xanthogranuloma with severe fibrotic reaction in the gallbladder wall, and four of these patients were treated by open operation. Although XGC has a relatively high conversion rate to open cholecystectomy, we conclude that patients with XGC should be considered for LC after an adequate patient selection, a clear visualization of anatomic structures and landmarks, and an intraoperative frozen-section examination.