The spilled stone

Abstract

The application of laparoscopic techniques in digestive surgery to areas in which there was no previous experience has favored the appearance of new complications and clinical situations that were not observed during the open era. Initial opinion considered that stones left in the abdominal cavity were harmless, and a few clinical and experimental studies supported this opinion. But cumulative reports of cases suggest a potential danger. From 1991 to date, 49 cases of complications related to stones left in the abdominal cavity have been reported with severe complications that required an open surgical procedure. Stone spillage has not always been considered an indication of conversion of laparoscopic cholecystectomy but is now accepted as a source of infrequent but severe complications that may require a reintervention for treatment. Therefore it is recommended that efforts should be made to retrieve all spilled stones; the surgical procedure should be prolonged until this is achieved, in order to reduce one source of unpredictable morbidity. Open retrieval should be considered in selected cases if a large number or large stones are lost.

Clipless Laparoscopic Cholecystectomy by Ultrasonic Dissection

“…[12][13][14][15][16][17][18][19] The reported incidence of gallbladder perforation during the laparoscopic cholecystectomy ranged from 10 to 40% in some studies. 31 Janssen et al prospectively randomized 199 patients to either ultracision or electrcautery in the dissection of the gallbladder from the liver bed in the laparoscopic cholecystectomy. 15 The use of ultracision was associated with a statistically significant lower incidence of gallbladder perforation, compared to electrocautery (16 vs. 50%, respectively; P Ͻ 0.001).…”

The Outcome of Gallbladder Perforation during Laparoscopic Cholecystectomy

“…Similarly in our series, the incidence of GBP was 29% for the first 100 cases, where it was 8% for the rest. It is likely that the experienced surgeon carries out the case without damaging the gallbladder wall, even under conditions of great difficulty (13)(14)(15). GBP occurs more frequently in patients with pigment stones.…”

Umbilical sinus tract with gallstone extrusion after laparoscopic cholecystectomy

“…Clinically, lost stones were incidentally the cause of small-bowel obstruction [6], subcutaneous abscesses [6,17,21,22], intraabdominal abscesses [3,11,19,23], and enteric and cutaneous fistulas [2,7,15]. Stones were found subdiaphragmatic, subhepatic, intrapelvic, and intrathoracic.…”

“…In case stones are lost, an attempt should be made to retrieve all gallstones by suctioning, grasping, or using a Dormia basket. The area should be irrigated extensively [3,7,8,12,14,17,20].…”