The management of xanthogranulomatous cholecystitis
Gürcan Şimşek, Alpaslan Şahin, Şükrü Hakan Metin, Mehmet Eşref Ulutaş, Kemal Arslan
Clinic of General Surgery, University of Health Science Konya City Hospital, Konya, Turkey
Abstract
Objective: Xanthogranulomatous cholecystitis (XGC) is a rare variant of chronic cholecystitis. This rare pathology is characterized by severe and progressive fibrosis of the gallbladder wall as well as infiltration of fat-laden macrophages.
Material and Methods: The final pathology report of 8213 cholecystectomies performed between 2011 and 2019 was evaluated retrospectively, and patients whose pathology result was reported as XGC were included in the study. Patients’ demographic characteristics, pathology results, and surgical methods were evaluated. Logistic regression analysis was performed for risk factors on conversion to open cholecystectomy.
Results: The rate of XGC among cholecystectomies was 0.91%. Mean age of the patients was 57.32 years. Laparoscopic cholecystectomy was applied to 92% (n: 69) of the patients. None of the patients had cancer suspicion in the preoperative period, but cancer suspicion was found in 10.6% of the patients during the operation. With the frozen test, unnecessary surgeries were prevented in these patients. Conversion rate to open cholecystectomy was found to be 26.09%. The most common reason for conversion to open cholecystectomy (66.7%) was intense fibrosis. Increased gallbladder wall thickness and acute cholecystitis were found to be statistically significant risk factors in ultrasonography (p< 0.05). Total complication rate in XGC cases was 3.9%.
Conclusion: XGC is an extremely rare disease and is difficult to diagnose before cholecystectomy. Especially in preoperative USG, in cases with no suspicion of malignancy, but with suspected malignancy during the operation, histopathological examination with frozen method before extensive surgery may prevent unnecessary dissection and related morbidities.
Keywords: Cholecystitis, xanthogranulomatous, laparoscopic cholecystectomy
Cite this article as: Şimşek G, Şahin A, Metin ŞH, Ulutaş ME, Arslan K. The management of xanthogranulomatous cholecystitis. Turk J Surg 2021; 37 (3): 242-246.
Study approval obtained from SBU Hamidiye Scientific Research Ethics Committee (Date: 20.11.2020, Number: 20/445).
Externally peer-reviewed.
Concept - G.Ş.; Design - G.Ş.; Materials - Ş.H.M., A.Ş.; Data Collection and/or Processing - M.E.U.; Analysis and/or Interpratation - A.Ş.; Literature Review - G.Ş.; Writing Manuscript - G.Ş.; Critical Reviews - K.A.
The authors have no conflicts of interest to declare.
The authors declared that this study has received no financial support.