Maximos Frountzas1, Dimitrios Schizas2, Efstathia Liatsou3, Konstantinos P Economopoulos4, Christina Nikolaou5, Konstantinos G Apostolou3, Konstantinos G Toutouzas6, Evangelos Felekouras3. 1. First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, 114 Vas. Sofias Ave. 11527, Athens, Greece; Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, School of Medicine, 15B Ag. Thoma Str. 11527, Athens, Greece. Electronic address: froumax@hotmail.com. 2. First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece; Society of Junior Doctors, Surgery Workgroup, 75 Mikras Asias Str. 11527, Athens, Greece. 3. First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, School of Medicine, 17 Ag. Thoma Str. 11527, Athens, Greece. 4. Society of Junior Doctors, Surgery Workgroup, 75 Mikras Asias Str. 11527, Athens, Greece; Department of Surgery, Duke University Medical Center, 2301 Erwin Rd, Durham, NC 27707, USA. 5. Laboratory of Experimental Surgery and Surgical Research, National and Kapodistrian University of Athens, School of Medicine, 15B Ag. Thoma Str. 11527, Athens, Greece. 6. First Propaedeutic Department of Surgery, Hippocration General Hospital, National and Kapodistrian University of Athens, School of Medicine, 114 Vas. Sofias Ave. 11527, Athens, Greece.
Abstract
BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management. In addition, distinguishing XGC from gallbladder cancer preoperatively is still a challenge. The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC. DATA SOURCES: The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases from inception until June 2020. RESULTS: The laparoscopic cholecystectomy rate (34%) was almost equal to the open cholecystectomy rate (47%) for XGC. An important conversion rate (35%) was observed as well. The XGC cases treated by surgery were associated with low mortality (0.3%), limited intraoperative blood loss (58-270 mL), low complication rates (2%-6%), along with extended operative time (82.6-120 minutes for laparoscopic and 59.6-240 minutes for open cholecystectomy) and hospital stay (3-9 days after laparoscopic and 8.3-18 days after open cholecystectomy). Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome. In addition, complex surgical procedures, like wedge hepatic resections and bile duct excision were required during operations for XGC. CONCLUSIONS: XGC seemed to be a rare, benign inflammatory disease that presents similar features as gallbladder cancer. The mortality and complication rates of XGC were low, despite the complex surgical procedures that might be required in some cases.
BACKGROUND: Xanthogranulomatous cholecystitis (XGC) is a rare benign chronic inflammatory disease of the gallbladder that often presents as cholecystitis and most of the times requires surgical management. In addition, distinguishing XGC from gallbladder cancer preoperatively is still a challenge. The aim of the present systematic review was to outline the clinical presentation and surgical approach of XGC. DATA SOURCES: The present systematic review was designed using the PRISMA and AMSTAR guidelines. We searched MEDLINE, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases from inception until June 2020. RESULTS: The laparoscopic cholecystectomy rate (34%) was almost equal to the open cholecystectomy rate (47%) for XGC. An important conversion rate (35%) was observed as well. The XGC cases treated by surgery were associated with low mortality (0.3%), limited intraoperative blood loss (58-270 mL), low complication rates (2%-6%), along with extended operative time (82.6-120 minutes for laparoscopic and 59.6-240 minutes for open cholecystectomy) and hospital stay (3-9 days after laparoscopic and 8.3-18 days after open cholecystectomy). Intraoperative findings during cholecystectomies for XGC included empyema or Mirizzi syndrome. In addition, complex surgical procedures, like wedge hepatic resections and bile duct excision were required during operations for XGC. CONCLUSIONS: XGC seemed to be a rare, benign inflammatory disease that presents similar features as gallbladder cancer. The mortality and complication rates of XGC were low, despite the complex surgical procedures that might be required in some cases.