Laparoscopic Cholecystectomy for a giant Gallstone

Giant Gallstones – a Systematic Review

“…Gallstones are a major health concern, especially in affluent societies but majority of them (80%) are clinically "silent", and are treated expectantly [1][2]. In literature, there is no clear consensus over the precise dimension beyond which a gallstone may be labelled as large or giant but generally gallstones greater than 3 cm in any one dimension are termed as "large stones" whereas the stones larger than 5 cm are termed as "giant gallstones" [8][9][10]. In this review, as 5 cm was adopted by the authors as the threshold dimension for inclusion as giant stone, only one case was included from the series by Zoubi et al [12] and two cases with gallstones lesser than 5 cm (4.5 cm and 4.1 cm) were excluded.…”

“…Firstly, the bigger stones usually lead to inflammation that thickens the gallbladder wall and Raman et al [36] by their bivariate analysis have demonstrated a significant correlation between conversion of LC to open surgery and the gallbladder wall thickness. Secondly, due to presence of giant stone, it is highly chal lenging to grasp the gallbladder with the available laparoscopic tools and dissect safely to obtain the proper anatomical exposure of Calot's triangle, particularly when operation is performed in the setting of acute cholecystitis [10]. Furthermore, the giant stone due to pressure leads to a stretchedout wall and later the fistula formation, making dissection tricky.…”

“…"Large stones" are commonly defined as stones larger than 3 cm in any one dimension, and "giant stones", a rarer variant, have been generally defined as stones larger than 5 cm though, there is no clear consensus in literature over the measurements to be used to define a gallstone as "giant" or "large" [8][9][10].…”