Abstract / Summary
Gallbladder perforation is a frequent intraoperative event during laparoscopic cholecystectomy, yet it is commonly documented as a binary occurrence. This approach may overlook substantial clinical heterogeneity and limit accurate assessment of postoperative risk. Recent evidence suggests that the consequences of perforation may vary according to the characteristics of the defect, bile contamination, gallstone spillage and retrieval, severity of inflammation, and intraoperative corrective measures. We propose that future research move beyond binary reporting toward standardized intraoperative characterization of gallbladder perforation. A practical conceptual framework could integrate perforation characteristics, contamination-related factors, stone-related factors, and corrective measures into a reproducible severity classification. Such a classification could subsequently be prospectively validated against postoperative outcomes, including abscess and surgical-site infection, before being incorporated into clinical risk stratification. Standardized reporting may improve risk adjustment, facilitate comparison across studies and surgical registries, and ultimately support more individualized postoperative management following gallbladder perforation.