« Back

Gallbladder aspiration safe but unnecessary during elective laparoscopic cholecystectomy, researchers report

Friday, September 19 2008 | Comments

---

What's This? Although gallbladder aspiration can be performed safely during laparoscopic cholecystectomy, it does not appear to reduce the incidence of gallbladder perforation and subsequent complications in patients with normal-appearing gallbladders, according to the results of a small prospective, randomized, single-center study.

Between August 2005 and February 2007, 160 consecutive patients (22.5% male) with symptomatic cholelithiasis were randomized to either gallbladder aspiration or no aspiration before dissection. Each arm of the study comprised 80 patients. All surgeries were elective. All study participants had ultrasonically proven, uncomplicated, symptomatic cholelithiasis. Patients were followed up at 7 and 30 days postoperatively.

There were no significant differences between the 2 groups in any of the primary endpoints measured, including mean dissection time (P=.45); amount of gas used (P=.49); spillage of gallstones or bile into the abdominal cavity (P=1.00); liver bed bleeding (P=.30); or wound infection (P=1.00). In addition, while gallbladder perforations occurred in 13 patients (16.3%) in the aspiration group and 21 patients (26.3%) in the control group, the difference was not statistically significant (P=.12). The perforations were caused by dissection of the organ or by grasping forceps during traction. None of the perforations occurred during removal of the gallbladder from the abdomen.

Gallstones were spilled into the abdominal cavity in 4 of 13 patients (30%) and 3 of 21 patients (14%) with gallbladder perforations in the aspiration and control groups, respectively. Liver bed bleeding occurred in 17 patients (21.3%) and 12 patients (15%) in the respective groups, and each group had 2 wound infections on postoperative day 7; another occurred on postoperative day 30 in the aspiration group.

Although the authors did not find that gallbladder aspiration reduced operative time or the incidence of gallbladder perforations, it is a feasible and safe procedure, they said. And although it may be of some benefit in cases with a hydropic gallbladder or acute cholecystitis, "we do not advocate [gallbladder aspiration] in otherwise normal-appearing [gallbladders]," they noted. (Ezer A , et al. Am J Surg 2008;196:456-459.)

Print  |  E-mail