Hepatocarcinoma, gallstone disease and gallbladder carcinoma: a case report of a rare incidental association

We report a rare case of a patient operated on with a diagnosis of hepatic tumour and gallstone disease, which postoperatively was found to be a hepatocellular carcinoma associated with a gallbladder carcinoma. Spiral CT at admission showed only a hepatic mass in the 4th segment, compatible with hepatocellular carcinoma and gallbladder lithiasis. Cholecystectomy was performed followed by a wedge resection of the 4th segment of the liver. The histopathological examination revealed a well-differentiated hepatocellular carcinoma and, surprisingly, an adenocarcinoma of the gallbladder confined to the mucosa. The association of a hepatocellular carcinoma and gallbladder adenocarcinoma is extremely rare. This association, together with an analysis of the literature showing the increased incidence of gallstones in cirrhotic patients and the consequent greater surgical risk when undergoing subsequent cholecystectomy after liver resection, would suggest that cholecystectomy should be performed routinely during liver resection for hepatocellular carcinoma or cirrhosis, even for minor resections and when there are no evident signs of gallbladder disease.     

Acute severe cholecystitis with empyema presenting as a gallbladder mass,jaundice and Mirizzi Syndrome: A case report

IntroductionAcute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome (MS) is a complex surgical problem both diagnostically and in terms of management as it mimics both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma.Presentation of caseA 48-year-old gentleman was referred to us with biliary colic and weight loss with ultrasound findings of gallstones. At subsequent follow-up he became deeply jaundiced with deranged liver function and a CT showing a gallbladder mass and dilated biliary tree. Follow-up MRCP suggested XGC and concomitant MS, but a malignant process could not be excluded. Pre-operative fine needle aspiration cytology (FNAC) at the time of percutaneous biliary drainage for his jaundice demonstrated XGC with no evidence of malignancy. Given the dense inflammation and a tense empyema at laparoscopy, he underwent a subtotal fenestrating cholecystectomy. The final histopathological diagnosis was acute cholecystitis.DiscussionOur patient likely had unrecognised acute cholecystitis which progressed to a complex mass with empyema and type I Mirizzi Syndrome, ultimately resulting in severe obstructive jaundice mimicking gallbladder carcinoma. Given that a laparoscopic total cholecystectomy is dangerous in these cases of severe inflammation, a laparoscopic subtotal cholecystectomy has been shown to be a safe alternative to more invasive strategies and was successfully utilised in our patient.ConclusionAcute severe cholecystitis with empyema presenting as a gallbladder mass, jaundice and Mirizzi Syndrome is a rare manifestation that requires adequate pre-operative work-up to exclude malignancy. Subtotal fenestrating cholecystectomy is a safe and effective alternative to open surgery in these cases of complex inflammation.     

Port site recurrence of unexpected gallbladder carcinoma after a laparoscopic cholecystectomy: Report of a case

Unexpected gallbladder carcinoma was identified in a 71-year-old woman after she underwent a laparoscopic cholecystectomy (LC) for symptomatic cholelithiasis. A subsequent laparotomy for a resection of the liver bed and a dissection of the lymph nodes around the hepatoduodenal ligament was done. Two and a half years later, the patient developed subcutaneous metastasis at the epigastric trocar site through which the gallbladder was removed. A third operation was thus performed, revealing no evidence of peritoneal dissemination, liver metastasis, or lymph node metastasis, and the abdominal wall mass was resected. The histological findings confirmed the diagnosis of metastatic carcinoma of the gallbladder. We recommend that when planning LC, the possibility of malignancy should thus be kept in mind. However, if there is any sign which does not completely exclude malignancy, such as a contracture or wall thickness of the gallbladder, LC should be performed by the abdominal wall lifting method and using a protective bag for the removal of the gallbladder.     

Gallbladder ascariasis with acute hepatitis. Conservative treatment

We report two cases of gallbladder ascaridiasis associated with acute hepatitis, its clinical evolution with conservative treatment, making diagnosis by both laboratory and ultrasono-graphic studies. Case 1: was a male in his early forties who experienced symptoms of acute hepatitis and cholecystitis within a time lapse of 72 h of evolution. When laboratory tests and ultrasound (US) were done, an ascaris inside gallbladder was corroborated. There were also alterations compatible with acute non-viral hepatitis. Conservative treatment was done with observations within an 8-day period that hepatic examinations were normal as well as absence of helminthus inside gallbladder. Case 2: A 10-year-old female, who expelled worms 8 months previously had 11 days evidence of acute cholecystitis and hepatitis. An ultrasound of liver and biliary tract was done, with evidence of Ascaris lumbricoides inside gallbladder, with alterations in hepatic tests. This was medically treated, achieving expulsion of the Ascaris lumbricoides from inside the gallbladder and normalization of liver function tests. Gallbladder ascaridiasis management may be conservative. Patient general condition must be evaluated, as well or medical evolution and associated pathologies that may interfere in certain ways in surgery. Follow-up of these patients must be strict, with medical evaluation and laboratory controls.     

Aberrant biliary ducts and cysto-hepatic ducts. A comprehensive study]

Though very different, aberrant bile ducts and cysto-hepatic ducts are often confused. Aberrant bile ducts are abnormal ducts which do not drain any segment or sector of the liver. They are filled of bile counter-flow and can be injured not only in the gallbladder bed, but also elsewhere on the surface of the liver. Cysto-hepatic ducts are normal ducts, draining segment or sector of the liver, but because of an embryologic sliding, their branching is on the gallbladder or on the cystic duct. All these ducts can be injured during cholecystectomy, and it would be of importance to recognize the true type of duct one has to deal with, by radiologic explorations. The management is different as aberrant bile ducts need only to be ligated, instead, the cysto-hepatic ducts may require a reimplantation in the common bile duct or Roux en y loop. We discuss all these problems on the basis of 1200 traditional cholecystectomies where 1 aberrant bile duct, 3 cysto-hepatic ducts, and 3 external biliary fistulas were encountered.     

Cholecystectomy, liver resection, and pyloruspreserving pancreaticoduodenectomy for gallbladder cancer: Report of five cases

Carcinoma of the gallbladder is an uncommon yet highly malignant disease with a poor overall prognosis. Surgical resection offers the only hope for cure in patients with this type of cancer, but resection is often impossible because of advanced disease at the time of presentation. Patients with locally dvanced gallbladder cancer, however, may occasionally be amenable to management by adding pancreaticoduodenectomy to cholecystectomy and liver resection. A retrospective review of patient records at the Johns Hopkins Hospital identified five patients with gallbladder cancer with peripancreatic lymph node involvement, who were treated by surgical resection including pancreaticoduodenectomy. The preoperative evaluation, operative technique, pathologic findings, and outcome were reviewed for each patient. Follow-up was obtained via clinic visit or telephone contact. All five patients underwent resection of the gallbladder cancer with an operation that included pylorus-preserving pancreaticoduodenectomy to remove the peripancreatic lymph nodes. In addition, four of the five patients underwent a nonanatomic liver resection. There were no in-hospital deaths. Two patients had postoperative complications; one had persistent drainage from a T-tube site and one had an anastomotic leak from the hepaticojejunostomy. Four patients have died of recurrent tumor during follow-up at intervals ranging from 11 months to 23 months. The fifth patient is alive and free of clinical disease at 42 months after operation. Carcinoma of the gallbladder is a highly malignant disease that is often not amenable to surgical cure. There is a select group of patients, however, in whom adding a pylorus-preserving pancreaticoduodenectomy can result in a potentially curative operation by removing extensive regional spread to the peripancreatic lymph nodes.     

Surgical management of gallbladder cancer

Gallbladder cancer is a very common malignancy in the northern part of India. Surgery is the only potentially curative modality of treatment for this disease. Radical cholecystectomy is the optimal surgical standard for resectable gallbladder cancer. This includes cholecystectomy, liver resection (wedge, segments 4b and 5, or extended right hepatectomy), and regional lymphadenectomy along the hepatoduodenal ligament, behind the duodenum and pancreatic head, common hepatic artery and celiac axis. Controversies regarding extent of liver resection, lymphadenectomy and role of multiorgan resection have been discussed. Incidental gallbladder cancer is often detected on histopathologic examination of the simple cholecystectomy specimen removed for a presumed gallstone disease. Revision surgery should be performed for incidental cancers that invade muscularis propria or beyond (T1b or more). Advanced gallbladder cancer should be treated non-operatively with a palliative intent. Obstructive jaundice in the setting of an advanced gallbladder cancer can be palliated with biliary stenting by endoscopic or transhepatic means. Occasionally, a surgical biliary bypass may be indicated to relieve intractable pruritus in a jaundiced patient with gallbladder cancer. There is no role of a planned R2 resection of advanced gallbladder cancer for the purpose of cytoreduction. Further improvement in the management of gallbladder cancer will need integration of systemic chemotherapy with radical surgery.     

The ultrasonographic 'triangular cord' coupled with gallbladder images in the diagnostic prediction of biliary atresia from infantile intrahepatic cholestasis

PURPOSE: The aim of this study was to evaluate the importance of the ultrasonographic "triangular cord" (TC) coupled with gallbladder images in the diagnostic prediction of biliary atresia (BA) from infantile intrahepatic cholestasis. METHODS: Seventy-nine infants with cholestatic jaundice underwent ultrasound examinations, focusing on the TC and gallbladder images. The TC was defined as visualization of a triangular or bandlike periportal echogenicity (3 mm or greater in thickness), which represents a cone-shaped fibrotic mass cranial to the portal vein in infants with BA. An abnormal gallbladder (nonvisualized or small) was thought to be more suggestive of BA than infantile intrahepatic cholestasis. RESULTS: Among 25 infants with BA, 21 showed TC, whereas 4 had no TC. Fifty-three of 54 infants with infantile intrahepatic cholestasis had no TC, showing a diagnostic accuracy of 94% with 84% sensitivity and 98% specificity. As for positive predictive value in the diagnosis of BA by the TC coupled with gallbladder images, it was 100% when a positive TC was coupled with an abnormal gallbladder and 88% when a positive TC was coupled with a normal gallbladder. It decreased to 25% when a negative TC was coupled with an abnormal gallbladder. CONCLUSIONS: The TC appears to be a very specific and definite ultrasonographic finding in the early diagnosis of BA. Positive TC regardless of gallbladder images is highly suggestive of BA, showing a 95% positive predictive value, but BA cannot be ruled out when negative TC is coupled with an abnormal gallbladder, requiring further diagnostic modalities such as liver needle biopsy or hepatobiliary scintigraphy.     

Mixed Adenoneuroendocrine Carcinoma of the Gallbladder

Mixed adenoneuroendocrine carcinoma rarely occurs in the gallbladder. Most cases of cholecystic mixed adenoneuroendocrine carcinoma have been reported from Asia, North American, and Europe; however, there is scarce literature available on this tumor in other populations. Here, we report a case of mixed adenoneuroendocrine carcinoma in a Melanoderm woman who was initially suspected to have gallbladder cancer. No specific symptoms or abnormal blood test results were observed preoperatively. Magnetic resonance imaging revealed a 7-cm hypointense mass in the gallbladder fossa, which invaded the surrounding liver segments. Radical cholecystectomy, partial liver resection, and regional lymphadenectomy were performed. Finally, she was diagnosed as mixed adenoneuroendocrine carcinoma of the gallbladder upon postoperative pathological examination and immunohistochemical staining. She received six cycles of systemic chemotherapy and somatostatin treatment and survived 21 months after surgery. Our case highlights the fact that mixed adenoneuroendocrine carcinoma of the gallbladder can occur in African populations as well. Surgical approach combined with adjuvant chemotherapy and somatostatin treatment may contribute a relatively good survival outcome.     

Don’t cry over spilled stones? Complications of gallstones spilled during laparoscopic cholecystectomy: case report and literature review

The gallbladder is perforated and stones are spilled more frequently during laparoscopic cholecystectomy than during open cholecystectomy. Recent reports have implicated spilled gallstones as a source of infrequent but serious complications of laparoscopic cholecystectomy. They can cause serious morbidity, and in most cases the patient will require open surgery for management of these complications. The authors report the case of a patient who was ill for 14 months after laparoscopic cholecystectomy when spilled stones formed a nidus for intra-abdominal abscess and colocutaneous fistula. Every effort must be made to prevent gallbladder perforation. When it does occur, all stones should be retrieved. Attempts at repairing gallbladder perforations are often unsatisfactory. A simple solution to this potential problem is to retrieve all stones immediately, place them in an intraperitoneal specimen bag, and “park” the bag on the liver. As soon as the gallbladder is dissected off the liver it should be placed in the specimen bag with the stones and removed through the umbilical port opening.     

Gallbladder adenomyomatosis: Diagnosis and management

IntroductionGallbladder adenomyomatosis is a benign acquired gallbladder disease. It can mimic cancer on radiological findings, leading to a diagnostic dilemma. The management and prognosis of these two gallbladder anomalies are entirely different. Therefore, it is essential to recognize the pathognomonic features of gallbladder adenomyomatosis is in order to accurately diagnose this pathology. This paper presents two encountered cases of gallbladder adenomyomatosis is, their diagnostic modalities as well as the algorithmic approach of their management. These two-case reports have been reported in line with the SCARE Criteria 2020 [1].Presentation of casePatient-1 was symptomatic. He was explored by an abdominal ultrasound picturing gallbladder wall thickening while the biopsy showed pleomorphic proliferation of inflammatory cells. An examination of the liver with MRI was indicated, showing diffuse parietal thickening with multiple cystic pockets. He underwent laparoscopic cholecystectomy with simple operative follow-up. Patient 2 was asymptomatic, a staging CT scan of acute pancreatitis revealed focal mural thinking of the gallbladder wall. A liver MRI showed an intramural cystic formation in the vesicular fundus. Given the inconclusive imaging results, laparoscopic cholecystectomy was performed. Histological examination confirmed the diagnosis of GA.DiscussionAdenomyomatosis is usually asymptomatic. Imaging can confirm the diagnosis of gallbladder adenomyomatosis without the need for invasive procedures such as vesicular biopsy. Histologic examination can also confirm the diagnosis when cholecystectomy is done. High resolution ultra-sound is the most efficient radiological examination. Laparoscopic cholecystectomy is the gold standard for symptomatic GA or radiological suspicion of a gallbladder cancer.ConclusionThe practitioner should always consider gallbladder carcinoma before confirming the GA, as they share the same features but with a far worse prognosis. The likelihood of malignancy depends on radiological characteristics. In the case of inconclusive findings, cholecystectomy is justified.     

Complications of gallstones: the Mirizzi syndrome, gallstone ileus, gallstone pancreatitis, complications of "lost" gallstones

Gallstones cause various problems besides simple biliary colic and choplecystitis. With chronicity of inflammation caused by gallstone obstruction of the cystic duct, the gallbladder may fuse to the extrahepatic biliary tree, causing Mirizzi syndrome, or fistulize into the intestinal tract, causing so-called gallstone ileus. Stones may pass out of the gallbladder and travel downstream through the common bile duct to obstruct the ampulla of Vater resulting in gallstone pancreatitis, or pass out of the gallbladder inadvertently during surgery, resulting in the syndromes associated with lost gallstones. This article examines these varied and complex complications, with recommendations for management based on the literature, the data, and perhaps some common sense.     

Ectopic liver (choristoma) associated with the gallbladder encountered during laparoscopic cholecystectomy: a case report

Ectopic liver has been but rarely described usually in the vicinity of liver such as on the gallbladder, hepatic ligaments, diaphragm, thoracic cavity, adrenal glands, pancreas, omentum, spleen, esophagus and umbilical cord. A simple classification for anomalous liver tissues found on the wall of gallbladder is 1. Accessory liver lobe 2. Ectopic nodule 3. Aberrant microscopic tissue. Ectopic nodules of liver tissue attached to the gallbladder are completely detached from the liver and has been described by various names such as accessory lobe, ectopic liver, accessory liver and heterotopic liver but the specific pathological term for this entity is choristoma introduced by Albert in 1904 meaning displacement. Several possible mechanisms may explain ectopic liver at various sites such as the development of an accessory lobe of the liver with atrophy or regression of the original connection to the main liver or migration of pars hepatica to the rudiment of various organs. In this paper we present a case of ectopic liver or choristoma attached to the gallbladder encountered during an elective laparoscopic cholecystectomy which was successfully removed with the gallbladder.     

The honeycomb gallbladder: a new category of acquired pseudo-multiseptate gallbladder

We report two cases of honeycomb gallbladder as a new category of acquired pseudo-multiseptate gallbladder associated with chronic cholecystitis with stones. The two patients were elderly women without any abdominal symptoms or abnormality of laboratory data. On the imaging examinations, a hyperechoic collection with acoustic shadowing on the inferior surface of the liver was typically observed on ultrasonography, with multiloculated gallbladder being observed on computed tomography. Macroscopic findings of the cut plane of the gallbladder showed a characteristic appearance, with thin pseudo-septations arising from the wall and bridging the lumen from side to side, with a honeycomb appearance, including small stones. Microscopic findings suggest that these septational structures could have developed over a chronic inflammatory course after acute obstruction of the cystic duct. Cholecystectomy should be the choice of treatment for honeycomb gallbladder from the viewpoint of clinical management.     

A rare gallbladder ciliated foregut cyst in chronic cholecystitis

IntroductionCiliated foregut cysts (CFC) are rare anomalies due to aberrant embryological development. It is thought to arise from a remnant of the embryologic foregut. The solitary cysts are characterised by ciliated pseudostratified columnar epithelium. They are usually located above the diaphragm but they can also arise in relation to the liver, gallbladder and pancreas.Presentation of caseWe present the first ciliated foregut cyst of the gallbladder case reported in Australia, and the ninth known case to be reported worldwide. A 61-year-old male with chronic cholecystitis and cholelithiasis underwent an elective laparoscopic cholecystectomy and intraoperative cholangiogram. Intraoperatively, ‘out-pouching’ was noted on the lateral border of the gallbladder. Microscopically the histopathology showed that the cyst was lined by ciliated columnar epithelium the characteristic feature of a ciliated foregut cyst.DiscussionTo date only 8 cases of these ciliated foregut cysts in the gallbladder have been reported in literature. Our case is the first reported in Australia. It is unique in that the patient was an older male as opposed to most other previous cases, which were younger females. These cysts can be difficult to distinguish from neoplasms clinically and radiographically. Reports have shown that these cysts may become dysplastic and is best excised when discovered.ConclusionDespite the rarity of CFCs and their potential to mimic malignancy, we propose awareness and understanding of the management for them—being excision and hopefully not cause any confusion or devastatingly allow it to become malignant.     

Left-sided gallbladder associated with congenital hypoplasia of the left lobe of the liver: a case report and review of literature

Left-sided gallbladder is a rare anomaly that is often associated with other abnormal anatomy in the hepatobiliary system. We report our experience of a case of left-sided gallbladder associated with the congenital hypoplasia of the left lobe of the liver. A 71-year-old woman underwent cholecystectomy for acute cholecystitis. Intraoperative findings revealed the absence of the left lobe of the liver. The gallbladder was located in the left side of the round ligament, which was associated with abnormal intrahepatic portal branching. The incidence of left-sided gallbladder without situs inversus is very rare. The following anomalous anatomy associated with left-sided gallbladder should be a concern when a surgeon encounters a left-sided gallbladder: right-sided round ligament associated with abnormal intrahepatic portal branching and ectopic gallbladder attached to the left lobe of the liver that connects to the left hepatic duct via the cystic duct or the accessory bile duct.     

Spilled gallstones during laparoscopic cholecystectomy

Introduction

Incidental gallbladder cancer is found in 0.6–2.1% of patients undergoing laparoscopic cholecystectomy for symptomatic gallstones. Patients with Tis or T1a tumours generally undergo no further intervention. However, spilled stones during surgery may have catastrophic consequences. We present a case and suggest aggressive management in patients with incidental gallbladder cancer who had spilled gallstones at surgery.

Case History

A 37-year-old woman underwent a laparoscopic cholecystectomy for symptomatic gallstones, during which some stones were spilled into the peritoneal cavity. Subsequent histological examination confirmed incidental pT1a gallbladder cancer. Hepatopancreatobiliary multidisciplinary team discussion agreed on regular six-monthly follow-up. The patient developed recurrent pain two years after surgery. Computed tomography revealed a lesion in segment 6 of the liver. At laparotomy, multiple tumour embedded gallstones were found on the diaphragm. Histological examination showed features (akin to the original pathology) consistent with a metastatic gallbladder tumour.

Conclusions

This case highlights the potential for recurrence of early stage disease resulting from implantation of dysplastic or malignant cells carried through spilled gallstones. It is therefore important to know if stones were spilled during original surgery in patients with incidental gallbladder cancer following a laparoscopic cholecystectomy. Aggressive and early surgical management should be considered for these patients.     

A pathological study of relatively early stage cancers of the gallbladder, and the significance of the full thickness cholecystectomy

The mode of extension of relatively early-stage gallbladder cancer(ss) was studied by microscopic serial sections in 25 patients. We also investigated the detached surface of the liver bed and gallbladder wall. No intrahepatic infiltration was noted in ss cancer and no recurrence occurred in the liver bed surface when a full-thickness resection was performed. The ss cancers in the fundus and in the body were found to extend subserously in the direction of the cervix or circumferentially. The infiltration reached the surrounding area of the common hepatic duct in 3 cases. Mucosal expansion showed the same directional tendency, but usually did not reach the cystic duct. On the other hand, the ss cancers of the cervix and the cystic duct frequently showed subserosal extension into the periductal interstitial tissue in the hepatoduodenal ligament. These results suggest that recurrence of ss cancers of the fundus and body after simple cholecystectomy might be partially caused by incomplete resection of the liver bed portion of the gallbladder wall, and a full-thickness cholecystectomy for cholecystolithiasis was considered to be useful to decrease the risk of recurrence of occult gallbladder carcinoma.     

The deceitful diagnosis of gallbladder volvulus: A case report

Introduction and importanceThe gallbladder volvulus is a rare but life-threatening condition characterized by an axial torsion of the gallbladder along the cystic pedicle, causing gallbladder ischemia and necrosis. This paper aims to present and discuss a rare case of gallbladder volvulus. This case report has been reported in line with the SCARE criteria 2020 [1].Case presentationWe report the case of a 90-year-old female patient who presented to the emergency room with sharp right upper abdominal quadrant pain of acute onset associated with vomiting, evolving for the last 12 h. She had no fever nor jaundice. Her body mass index (BMI) was 22. She had kyphosis, and scoliosis. Physical examination found tenderness with a palpable mass in the right upper abdominal quadrant. Laboratory test results showed leukocytosis at 11600 /mL and a high C-reactive protein rate at 40 mg/L revealed acute calculous cholecystitis features. However, emergency laparotomy was performed and discovered a gallbladder volvulus. A detorsion and cholecystectomy were performed with a good outcome.Clinical discussionThe preoperative diagnosis of gallbladder volvulus is difficult due to its misleading clinical presentation mimicking acute cholecystitis. The presence of the three highly suggestive triad clinical signs should encourage the radiologist to search for a gallbladder with a horizontal orientation and located outside its anatomical fossa connected to the liver by a conical structure corresponding to the twisted pedicle in ultrasonography. Unlike ordinary acute cholecystitis, which may sometimes tolerate an initial conservative medical treatment, gallbladder volvulus management is always an emergency cholecystectomy.ConclusionDespite the clinical similarities with the classical acute calculous cholecystitis, gallbladder volvulus is more likely to result in fatal outcome. Therefore, a high level of clinical suspicion is necessary to save lives.     

Laparoscopic staging in gallbladder cancer

PURPOSE: Laparoscopy is beneficial in the staging of pancreatic and upper gastrointestinal malignancies but its role in gallbladder cancer has not been investigated. We evaluated the role of laparoscopy in the staging of gallbladder cancer. Methods: From 1989 through 2001, 91 patients with gallbladder cancer, without any evidence of metastatic disease on imaging (ultrasound and/or computed tomographic scan), underwent staging laparoscopy. Peritoneal and surface liver metastases were looked for and assessment of local spread was done if possible. Assessment was based on visual impression and biopsies were not obtained routinely. RESULTS: At laparoscopy, 34 (37%) patients had disseminated disease in the form of liver and/or peritoneal deposits; no further surgery was performed in 29 of these patients while 5 patients underwent surgical bypass procedures. Liver metastases were missed at laparoscopy in 2 patients and were subsequently found at laparotomy. Assessment of the gallbladder mass was possible in 33 (36%) patients, 6 of these were found to have extensive local disease and did not undergo any further surgery. Laparoscopic staging, thus avoided further surgery in 35 (38%) patients. Of the 51 patients without metastatic disease, who underwent laparotomy, 11 were found to have nonresectable locally advanced disease while 1 had liver metastases, which were missed at laparoscopy; 7 underwent bypass procedures only; 21 underwent simple cholecystectomy and extended cholecystectomy was done in 11 patients. The resectability rate (number of resections/operations) in patients undergoing laparoscopic staging was 57% (32/56) as compared with 43% (142/328) in those who did not undergo laparoscopy. CONCLUSIONS: Staging laparoscopy in patients with gallbladder cancer detected liver and peritoneal metastases that were missed on imaging. It reduced the number of unnecessary surgical explorations and improved the resectability rate.