Retroperitoneoscopy to Extract Dropped Gallstones After Laparoscopic Cholecystectomy

Abstract

Complications resulting from gallstones left in the peritoneal cavity are most often reported after laparoscopic treatment of cholelitiasis. Gallstones are frequently dropped in the posterior subhepatic space, which can lead to the development of abscesses that usually require laparotomy for extraction of the stones. We present a novel technique for treating collections associated with dropped gallstones, using retroperitoneoscopy with two 10-mm ports after ultrasound localization of the abscess. We carried out this procedure in two patients and successfully extracted the gallstones without postoperative complications or recurrences. We consider this approach to be technically feasible, safe, and effective. It avoids the usual inefficacy of simple percutaneous drainage of these collections and the complications associated with the drainage of intra-abdominal abscesses by laparotomy.

Dropped Gallstone-Related Right Subhepatic and Parietal Wall Abscess: A Rare Complication After Laparoscopic Cholecystectomy

“… 5 , 9 , 10 Laparoscopy is less invasive, and the procedure can be performed through the retroperitoneal approach. 10 In many cases, laparoscopic and percutaneous technique may not be feasible because of the inaccessible location of the abscess and surrounding dense adhesions. An open approach therefore is preferable.…”

“…5,6 There are several options for the management of dropped gallstone-related abscess such as percutaneous technique, laparoscopy, and laparotomy. 5,9,10 Laparoscopy is less invasive, and the procedure can be performed through the retroperitoneal approach. 10 In many cases, laparoscopic and percutaneous technique may not be feasible because of the inaccessible location of the abscess and surrounding dense adhesions.…”

Ultrasound-guided percutaneous retrieval of a dropped gallstone following laparoscopic cholecystectomy

“…3 Surgical options available for the extraction of dropped gallstones carry increased risks of post-operative morbidity. 4 We describe a novel, minimally invasive, ultrasound-guided technique to successfully remove a dropped gallstone, causing intraabdominal sepsis, from a patient who had undergone laparoscopic cholecystectomy.…”

“…Surgical options for stone removal include laparoscopy, providing a less invasive approach. 4 However, the majority of reported surgical cases underwent laparotomy and surgical exploration for stone retrieval. This is often due to the deep and inaccessible location of the stones.…”

Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones – A Case Series

“…The latter approach (laparoscopy) is often met with challenges because the stones are usually present in deep and inaccessible areas, rendering them ineffective. On the other hand, exploratory laparotomy is associated with an increased risk of postoperative morbidity 7,8 …”