Gallbladder perforation with fistulous communication

BACKGROUND The management of gallbladder perforation(GBP)with fistulous communication(Neimeier type I)is controversial.AIM To recommend management options for GBP with fistulous communication.METHODS A systematic review of studies describing the management of Neimeier type I GBP was performed according to the PRISMA guidelines.The search strategy was conducted in Scopus,Web of Science,MEDLINE,and EMBASE(May 2022).Data extraction was obtained for patient characteristics,type of intervention,days of hospitalization(DoH),complications,and site of fistulous communication.RESULTS A total of 54 patients(61%female)from case reports,series,and cohorts were included.The most frequent fistulous communication occurred in the abdominal wall.Patients from case reports/series had a similar proportion of complications between open cholecystectomy(OC)and laparoscopic cholecystectomy(LC)(28.6 vs 12.5;P=0.569).Mortality was higher in OC(14.3 vs 0.0;P=0.467)but this proportion was given by only one patient.DoH were higher in OC(mean 26.3 d vs 6.6 d).There was no clear association between higher rates of complications of a given intervention in cohorts,and no mortality was observed.CONCLUSION Surgeons must evaluate the advantages and disadvantages of the therapeutic options.OC and LC are adequate options for the surgical management of GBP,with no significant differences.

Letter to the Editor concerning:Gallbladder perforation:A single-center experience in north India and a step-up approach for management

To the Editor:We sincerely applaud the work done by Gupta et al.,in which they analyzed a single-center experience regarding gallbladder per-foration(GBP)management[1].Currently,there is a lack of cohort studies to adequately describe the approach strategies and man-agement for this pathology,with international guidelines making ambiguous recommendations[2,3].Their study stratified GBP types and provided details regarding clinical presentation,comorbidities,preoperative diagnosis,etiology,imaging techniques,and surgical approach.The study reported a high conversion rate when a la-paroscopic approach was attempted for cholecystectomy.