Dropped Gallstones During Laparoscopic Cholesystectomy: The Consequences

Abstract

During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences.

Improvised laparoscopic stone picker

“…During the process frequently the gall bladder gets ruptured and the stones are scattered. These scattered stones frequently lead to complication as intra-abdominal abscess [1][2][3], adhesion between loops of gut complicating as obstruction etc.…”

Case Report Related to Laparoscopic Cholecystectomy

“…A prospectively maintained database of 1528 patients showed complications in 12% of gallstone spillage patients. 6 To avoid psychological trauma to the patient related to misdiagnosing cancer or performing unnecessary laparotomy, the surgeons should follow on those patients postoperatively. Ultrasound or CT is the most sensitive means for tracing spilled gallstones or abscesses.…”

Hallazgos imagenológicos en cálculos abandonados en cavidad abdominal posterior a colecistectomía por laparoscopia: serie de 7 casos y revisión de la literatura

“…El diagnóstico de los abscesos intraabdominales por cálculos puede confundirse con abscesos simples y actinomicosis hepática. También se ha encontrado que los abs-que requirió manejo médico, y a 5 se les diagnosticaron abscesos intraabdominales que fueron reintervenidos o drenados de manera percutánea y el cuadro se resolvió completamente (29).…”