Intraperitoneal Cholelithiasis after Laparoscopic Cholecystectomy-Behavior of ‘Lost’ Concrements and Their Role in Abscess Formation

Abstract

In two experimental studies we sought preliminary information about the behavior of concrements lost in the peritoneal cavity during laparoscopic cholecystectomy. Materials and Methods: In study 1, human gallstones were analyzed using X-ray diffraction, calssified in three groups and examined with an ultramicroscope; then they were implanted in the peritoneal cavity of rats. After 8 weeks or 6 months, the animals were sacrificed and the concrements analyzed again as before. The tissues surrouding the calculi were also examined histologically. In study 2, human gallstones were examined with regard to bacterial contamination on the surface or in the middle of the calculi. The cholesterol content was analyzed, and the stones were divided into three groups and implantated in the rats as in the first study. After 8 weeks, the animals were sacrificed and areas with identifiable tissue reactions were examined histologically and microbiologically. Results: The concrements lost their crystalline formation without any relation to their former cholesterol content, as shown by X-ray diffraction as well as ultramicroscopy. Mineralogically, these changes are a certain sign of structural dissolution. Cholesterol stones only caused abscess formations in association with gram-negative bowel germs. Sterile pigment concrements often led to a mesenchymal reaction such as granulomas. Contaminated pigment stones also resulted in extensive abscess formations.

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.…”

The fate of the dropped gallstones during laparoscopic cholecystectomy

“…In these studies gallstones implanted into the peritoneal cavity not only caused adhesions but also resulted in abscess formation [3,4,9].…”

“…Most of these reports describe trocar site abscesses with late discharge of stones or formation of intraperitoneal adhesions. Experimental animal studies have shown that gallstones left in peritoneal cavity, especially when combined with bile, are associated with the formation of adhesions and possible abscess formation [3,4,10,11]. Other experimental and clinical studies that investigated the long-term effect of spilled gallstones did not reveal increased morbidity [2,11].…”

The Incidence of Live Bacteria in Bile, Gallbladder Inner Wall and Gallstones in Gallstone Disease- A Search

“…intraperitoneal abscesses, intraperitoneal granuloma, wound infection, etc. Experimental studies have also confirmed that implantation of human gallstones in the peritoneal cavity of rat, rabbit and dog produces intraperitoneal abscesses, sinuses and adhesions, 10,11,12 which states that gallstone is a dynamic viable home of bacteria rather than a tomb.…”