Clinical Approaches and Outcomes in Localized Gallbladder Perforation: A Comprehensive Review

Abstract

Background: The ideal approach to handling localized gallbladder perforation, specifically Neimeier type II cases, remains uncertain [1], [2]. This systematic review was conducted with the objective of pinpointing factors linked to enhanced patient outcomes. Methods: Included in this systematic review were studies that detailed the management of Neimeier type II perforation, reported complications following the initial intervention, the need for additional interventions, resolution of the pathology, and the duration of hospitalization [3], [4]. Results: A total of 120 patients, with 52% being male, were included in the analysis. These patients were sourced from case reports, series, and cohorts. Among them, 54 (46%) underwent open cholecystectomy, while 46 (36%) underwent laparoscopic cholecystectomy. The overall risk of bias in the studies analyzed was determined to be moderate. Notably, the need for additional interventions was more frequent in the laparoscopic group (17 cases) compared to the open surgery group (5 cases), a statistically significant difference (p < 0.001). Similarly, the prevalence of complications was higher in the laparoscopic group (16 cases) in contrast to the open surgery group (4 cases), also demonstrating a significant difference (p < 0.001). Conclusion: Open cholecystectomy showed a reduced requirement for subsequent surgical interventions and experienced fewer postoperative complications compared to laparoscopic cholecystectomy. However, it was associated with an extended hospitalization period [5]. Notably, these outcomes remained consistent regardless of preoperative percutaneous drainage. Furthermore, the timing of cholecystectomy did not exert a significant influence on these outcomes.