The Fate of Intraperitoneally Retained Gallstones with Different Morphologic and Microbiologic Characteristics: An Experimental Study

Abstract

Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of stone morphology and clinically obvious infection on the outcome of retained gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study groups. "Intact-sterile-cholesterol" (group II), "crushed-sterile-cholesterol" (group III), and "intact" (n = 5) [group IVa] and "crushed" (n = 5) [group IVb] "infected-cholesterol" gallstones aseptically retrieved from three different human patients were implanted to the peritoneal cavity of the animals. Group IV animals were implanted with stones retrieved from an acutely inflamed gallbladder with proven infection. Animals were sacrificed 6 and 12 weeks after the operations. Cultures and tissue samples were obtained. No animal was lost, no microscopic or macroscopic abnormality was observed in groups I and II, and cultures remained negative. In group III, adhesions surrounding the fragmented stones were evident at the 12th week, and no mortality was encountered. The histopathology revealed a fibroblastic reaction, and cultures remained negative in group III. In group IV, three animals from group IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhesions with localized abscesses at the 12th week. In conclusion, intraperitoneally retained cholesterol gallstones remain inert and do not cause serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of patients that laparotomy for total stone clearance is probably not justifiable. Better stone retrieval techniques or even laparotomy may be worthwhile considering in patients with crushed and particularly infected retained stones.

Peritoneal gallstones following laparoscopic cholecystectomy

“…The inflammatory response is greater in the presence of infection [2,57], stone fragmentation [57], and with pigmented stones [18,20]. Pigment stones are more likely to be infected than cholesterol stones.…”

Gall Stone S Retrevial During Laproscopic Cholecystectomy

“…As shown in several studies, [2][3][4][5][6][7] whether the bile is infected or not, bile and gallstones are at an increased risk for abscess formation and formation of adhesions. The type of stones is one of the factors involved in complication occurrence; more experimental studies and reported cases show that the bacterial contamination is less in cholesterol calculi than in pigment stones (Black, brown or mixed).…”

“…[1][2][3][4][5][6][7][8] During laparoscopy, the incidence of gallbladder perforation is 13 to 40%, 21 with a mean of 18. 3%out of those 8 studies with more than 500 LCs.…”

Routine intraoperative aspiration of gallbladder during laparoscopic cholecystectomy

“…The experience of the surgeon and the difficulty of the operation (acute or chronic cholecystitis and adhesions in the right upper quadrant) are considered significant risk factors for gallbladder perforation during LC [6,8,16,17]. Inflammation in response to peritoneal gallstones is increased in the presence of infection, stone fragmentation, and pigmented stones [7,20].…”