Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview

Helme, Sophie; Samdani, Tushar; Sinha, Prakash

doi:10.4076/1752-1947-3-8626

Cited by 38 publications

(26 citation statements)

References 5 publications

(11 reference statements)

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“…12 Morishita et al 13 reported that spilled stones floating free in the peritoneal cavity may migrate to the pelvic area and become embedded there in the cul-de-sac, causing a severe reaction. Due to the subsequent inflammatory reaction, the fertility may be adversely affected in females.…”

mentioning

confidence: 99%

Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery

Singal¹,

Goyal²,

Zaman³

et al. 2017

WJOLS

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Aims and objectives:To compare three-port laparoscopic cholecystectomy (LC) with four-port LC in chronic calculous cholecystitis patients. We compared the feasibility of the procedure, total operative time, postoperative pain, incidence of complications, and cosmetic results. Materials and methods:The present study was conducted in the Department of Surgery at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. Totally, 200 adult patients of cholelithiasis with chronic cholecystitis were included in the study. These cases were randomly divided into two groups (I and II) consisting of 100 cases in each group. The study was conducted for a period of 1 year from April 2014 to March 2015. Three-port LC was performed in group I patients and four-port LC was performed in group II. The cosmetic results, incidence of postoperative complications, and operative time were noted in both the groups.The present study is being undertaken to compare the various merits and demerits of three-port LC vs four-port LC performed by the same surgical team in the same scenario, in terms of parameters mentioned subsequently and assess the feasibility of both the procedures in our setup in a medical college.Results: Gallstone disease is found to be more common in the 4th and 5th decades. Mean age of presentation was 41 years. Three-port LC is difficult in cases of dense adhesions. There were significant differences in operative time (93.16 minutes for three-port LC and 50.66 minutes for four-port LC). There was no significant difference due to type of operation. Cosmetic appearances for both the procedures were comparable. Conclusion:We concluded that both three-port and four-port cholecystectomies are equally good procedures in the hands of experienced laparoscopic surgeons. The complications, operative time, hospital stay, cosmesis, and disability days were comparable in both groups. The four-port technique should be accepted and adopted only by beginners in minimal access surgery. The operator who performs three-port LC should be prepared for placement of an additional port or conversion to open laparotomy whenever complication arises.

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mentioning

confidence: 99%

Comparison of Three-port vs Four-port Laparoscopic Cholecystectomy in a Medical College in the Periphery

Singal¹,

Goyal²,

Zaman³

et al. 2017

WJOLS

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“…If gallstones are spilled, the recommended secondary prevention consists of good irrigation with saline to dilute any infected bile, and all stones should be retrieved into a retrieval bag or even a surgical glove, if possible 12. The Sathesh-Kumar review also upheld the opinion that conversion to open surgery to retrieve spilled gallstones is not supported and would lead to overall increased patient morbidity.…”

Section: Discussionmentioning

confidence: 99%

Back to the gallstone: a mischievous cause of morbidity

Heron¹,

Manzelli

2016

BMJ Case Reports

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Laparoscopic cholecystectomies (LCs) are the gold standard treatment of symptomatic gallstone disease worldwide. However, with this technique comes the increased risk of retained spilled gallstones. We describe a case of a 77-year-old man who presented 2 months after undergoing a LC, with right upper quadrant pain. Abdominal ultrasound scan showed no significant complications, but he continued to have grumbling pains. These were investigated with an abdominal CT scan, prompting suspicion of a colorectal malignancy with pleural metastasis. However, on review by two different multidisciplinary teams, the final conclusion was probable residual gallstones with associated inflammation. This diagnosis was rather dramatically confirmed when the patient went on to expel gallstones percutaneously from his back and coughed out of his respiratory tract. This case highlights the importance of operative documentation of spilled gallstones, which can, in addition to more surprising consequences, mimic malignancy on investigation. This can lead to delay in correct management and cause undue patient distress.

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“…3–6 Established risk factors that predispose to gallbladder perforation during laparoscopic cholecystectomy are surgeon inexperience, acute cholecystitis, tensely distended gallbladder, right upper quadrant adhesive disease, thermal injury during dissection, and excessive traction. 3,7,8 …”

Section: Discussionmentioning

confidence: 99%

“…Peritoneal adhesions secondary to ectopic intraperitoneal gallstones have been reported in both animal models and humans. 8,16 The number of ectopic concrements within the peritoneal space and the presence of infected bile appears directly related to the development of adhesions. Cecal mobility as a result of abnormal peritoneal fixation and anatomical distortion secondary to intraperitoneal adhesions or masses are predisposing risk factors for cecal volvulus.…”

Section: Discussionmentioning

confidence: 99%