Laparoscopic Management of Xanthogranulomatous Cholecystitis (XGC): a Diagnostic and Therapeutic Challenge to Surgeons in Northern India

Xanthogranulomatous cholecystitis (XGC) is a benign condition with difficulties associated with its diagnosis and management. We present the 5-year experience of management and outcomes following laparoscopic cholecystectomy in the patients of a predominantly northern Indian population cohort. A retrospective study was conducted in patients who underwent laparoscopic cholecystectomy between January 2013 and December 2017. Pre-operative characteristics, intraoperative findings, and postoperative outcomes were obtained from medical records. Out of the 1513 patients who underwent laparoscopic cholecystectomy during the study period, 60 (3.9%) were histologically confirmed as XGC, 26 (43.3%) were men, and 34 (56.7%) were women with a mean age of 50.6 years (range 15–76). The mean follow-up period was 45.5 SD10.6 months. Most patients presented with right hypochondrium pain (63.6%). Cholelithiasis was the most common ultrasonographic (USG) finding (91.7%). On noting suspicious findings of malignancy on USG, a further contrast-enhanced computerized tomography (CECT) was performed, and if further doubt persisted USG-guided cytological examination was performed. Laparoscopic cholecystectomy was performed in 55 (91.7%) patients with a conversion rate of 8.3%. Eight patients underwent partial cholecystectomy. The overall complication rate was 10%, with no early (30-day) mortality. Laparoscopic cholecystectomy has shown effective results with minimal morbidity in the management of xanthogranulomatous cholecystitis (XGC). A comprehensive evaluation with CECT and image guided-FNAC may help in differentiating this condition from gallbladder carcinoma.