• Sarkhel Hama Tofiq Sulaimani Teaching Hospital, Directory of Health, Sulaimani, Kurdistan Region, Iraq.
  • Seerwan Hama Shareef Department of Surgery, College of Medicine, University of Sulaimani, Kurdistan Region, Iraq.



Iatrogenic gallbladder perforation, Laparoscopic cholecystectomy, Gallstone, Spillage of bile



Iatrogenic perforation of the gallbladder has been reported in 28% of those patients who undergo laparoscopic cholecystectomy. It has been pointed out that gallbladder perforation can result in spillage out gallstones and bile.


To investigate the perioperative incidence of iatrogenic gallbladder perforation during laparoscopic cholecystectomy in Sulaimani Teaching Hospital.

Patients and Methods

The present investigation was a single-centre, prospective observational study that was carried out in Sulaimani Teaching Hospital in 2018-2019. The study sample included 99 patients who had undergone elective cholecystectomy by multiple surgeons.

Required data on the possible risk factors and early outcomes and the patients’ demographics, including age, BMI, and gender, were collected. The collected data were analyzed through the Statistical Package for the Social Sciences (version 22.0).


The results revealed that 80% of the patients were females. Also, 42.4% had no chronic diseases. At the same time, diabetes mellitus (DM), DM along with hypertension (HT), and HT were the most prevalent chronic diseases among them with 18.2%, 16.2%, and 10.1% of prevalence, respectively. (Multiple attacks of cholestasis). Only 17.2% of the patients had an abdominal operation before, and acute cholestasis and chronic cholestasis were seen respectively in 13% and 17% of them. The most common causes of gallbladder perforation (GP) were found to be electrocautery (16.2%) and grasper (7.1%). 33.3% of the patients were overweight (BMI between 25 and 29.9), 45.5% were obese (BMI between 30 and 34.9), and 20.2% had a BMI of over 35. (Overweight or obese patients have a problematic view in laparoscopy) Most of the patients were aged 30 to 49 (62.6%). A majority of the patients (94.9%) were found to have gallstones. 


Iatrogenic gallbladder perforation is prevalent among patients who undergo laparoscopic cholecystectomy. However, laparoscopic cholecystectomy is still a better choice and is associated with fewer complications than open cholecystectomy. Required measures need to be adopted for patients with perforated gallbladder to minimize spillage and remove as much spilt gallbladder content as possible.


Cerçi S.S, Ozbek F.M, Cerçi C, Baykal B, Eroğlu H.E, Baykal Z, et al. Gallbladder function and dynamics of bile flow in asymptomatic gallstone disease. World Journal of Gastroenterology: WJG. 2009; 15(22), 2763–2767. DOI: 10.3748/wjg.15.2763. DOI:

Akmoosh M.A.R, Kandil M. Clinical outcomes of gall bladder perforation during laparoscopic cholecystectomy, Ann Trop Med & Public Health. 2019; 22(IV): S386. DOI: DOI:

Demiral G, Aksoy F. Single surgeon experience: intraoperative complications and conversion to open surgery in laparoscopic cholecystectomy, the fore and aft of 20 years experience. Biomedical Research. 2017; Volume 28, Issue 15.

Pandit N, Yadav T.N, Awale L, Deo K.B, Dhakal Y, Adhikary S. Current scenario of postcholecystectomy bile leak and bile duct injury at a tertiary care referral centre of Nepal. Minimally Invasive Surgery.; 4382307. DOI:

Altuntaş Y.E. Gallbladder Perforatıon Durıng Electıve Laparoscopıc Cholecystectomy: Incıdence, Rısk Factors and Outcome. Northern Clinics of Istanbul. 2017; doi:10.14744/nci.2017.88155. DOI:

Yethadka R, Shetty S, Vijayakumar A. Attitudes and practices of surgeons towards spilt gallstones during Laparoscopic cholecystectomy: An observational study. International Scholarly Research Notices.; 381514. DOI: DOI:

Abraham S, Rivero HG, Erlikh IV, Griffith LF, KondamudiVK. Surgical and non-surgical management of gallstones. American Family Physician. 2014; 795-802.

Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost Analysis and Supply Utilization of Laparoscopic Cholecystectomy. Minim Invasive Surg.; 7838103. DOI: 10.1155/2018/7838103. DOI:

Sanabria Trujillo R, Alberti Minutti P, Aldama López K.E. Incidencia del síndrome postcolecistectomía en pacientes adultos. Acta Médica Grupo Ángeles. 2021; 19(1), 61–66. DOI: 10.35366/98572. DOI:

Salih T.M. Complications of laparoscopic cholecystectomy in a sample of patients admitted to Al-Ramadi teaching hospital, Anbar-Iraq. Indian Journal of Forensic Medicine and Toxicology. 2020; doi:10.37506/ijfmt. v14i2.2827.

Krishnamurthy G, Ganesan S, Ramas J, Damodaran K, Khanna A, Patta R. Early laparoscopic cholecystectomy in acute gallbladder perforation: Single-centre experience. Journal of Minimal Access Surgery. 2021; 17(2), 153–158. DOI: 10.4103/jmas.JMAS_176_19. DOI:

Pisano, M., Allievi, N., Gurusamy, K. et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020; 15, 61. DOI:

Sahbaz, N. A., Peker, K. D., Kabuli, H. A., Gumusoglu, A. Y., & Alis, H. Single Centre experience in laparoscopic treatment of gallbladder perforation. Wideochirurgia i Inne Techniki Malo Inwazyjne [Videosurgery and Other Miniinvasive Techniques]. 2017; 4, 372–377. doi: 10.5114/wiitm.2017.72321. DOI:

Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94(3):311–321. doi: 10.1016/j.diabres.2011.10.029. DOI:

Gunasekaran, G., Naik, D., Gupta, A., Bhandari, V., Kuppusamy, M., Kumar, G., & Chishi, N. S. Gallbladder perforation: a single-centre experience of 32 cases. Korean Journal of Hepato-Biliary-Pancreatic Surgery. 2015; 19(1), 6–10. doi: 10.14701/kjhbps.2015.19.1.6. DOI:

Düzenli, T., Köseoğlu, H. Endoscopic Retrograde Cholangiopancreatography During the COVID-19 Pandemic: Effects of Enhanced Personal Protective Equipment. Dig Dis Sci. 2021; 66, 1845–1851. DOI:

Ahmad, M., Alsaffar, S., Tahir, E., & K. Mahjob, N.Harmonic versus electrocautery in the dissection of gall bladder in laparoscopic cholecystectomy. Annals of the College of Medicine, Mosul. 2013; 39(2), 107–112. DOI:

Enami, Y., Aoki, T., Tomioka, K. et al. Obesity is not a risk factor for either mortality or complications after laparoscopic cholecystectomy for cholecystitis. Sci Rep. 2021; 11, 2384. DOI:

Stinton LM, Myers RP, Shaffer EA. Epidemiology of gallstones. Gastroenterol Clin North Am. 2010;39:157–169. DOI:

Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: a mendelian randomization study. Hepatology 2013; 58:2133–2141. DOI:

Portincasa P, Wang DQ. Gallstones. In: Podolsky KD, Camilleri M, Fitz JG, Kalloo AN, Shanahan F, Wang TC, editors. Yamada’s Textbook of gastroenterology. Hoboken: Wiley-Blackwell. 2015; p. 1808–1834. DOI:

Johansson K, Sundstrom J, Marcus C, Hemmingsson E, Neovius M. Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight-loss program: 1-year matched cohort study. Int J Obes. 2014; 38:279–284. DOI:

EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. Journal of Hepatology. 2016; 65(1), 146–181. DOI:

Hu A.S.Y, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery - a systematic literature review of 30 studies, Am. J. Surg. 2017; 214 (5) (2017 Nov) 920–930, DOI:

Paajanen H, Kakela P, Suuronen S, Paajanen J, Juvonen P, Pihlajamaki K. Impact of obesity and associated diseases on outcome after laparoscopic cholecystectomy, Surg. Laparosc. Endosc. Percutaneous Tech. 2012; 22. 509–513. DOI:

Gregori, M., Miccini, M., Biacchi, D., de Schoutheete, J.-C., Bonomo, L., & Manzelli, A. (2018). Day case laparoscopic cholecystectomy: Safety and feasibility in obese patients. International Journal of Surgery (London, England). 2018; 49, 22–26. DOI: DOI:

Hanashe, R. F., Essa, H. T., & Abdul Razaq, M. A. W. Outcome of Perforated Gallbladder during Laparoscopic Cholecystectomy. AL-Kindy College Medical Journal. 2021; 17(1), 26–30. DOI: DOI:



How to Cite


Similar Articles

1-10 of 15

You may also start an advanced similarity search for this article.