The Case for Standardisation of the Management of Gallstones Spilled and not Retrieved at Laparoscopic Cholecystectomy

Mullerat, J.M.; Cooper, Kevin; Box, B.; Soin, Bob

doi:10.1308/003588408x285883

Cited by 25 publications

(27 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In a survey conducted by Mullerat [7], 80% of surgeons don’t have possibility of lost gallstones as part of informed consent. In our survey 55% participants agreed that the patient should be informed prior to surgery regarding possibility of lost gallstones as part of the informed consent.…”

Section: Discussionmentioning

confidence: 99%

“…For some surgeons the rarity of complications dismisses the prospects of converting the LC to an open procedure for retrieving the spilled stones, while for others the seriousness of complications demands that every effort be made to retrieve all gallstones spilled during the procedure. Mullerat [7] reported that only a fifth of surgeons include this phenomenon in the informed consent and only half the surgeons inform the patients in case the stones are lost during LC. They observed that informing the patients may aid in the diagnosis of the complications if in case they occur, but can also result in unnecessary anxiety and repeated examinations for rare complications.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey

et al. 2013

View full text Add to dashboard Cite

BackgroundGall bladder perforation, gallstone spillage and loss are commonly reported from Laparoscopic Cholecystectomy (LC). Though rare, lost gallstones can cause a variety of complications presenting variably from within 1 month to 20 years postoperatively. Our objective was to investigate knowledge and practices of surgeons and surgical residents regarding spilled gallstones lost during laparoscopic cholecystectomy.MethodsAn observational, cross-sectional survey, using a questionnaire based on 13 self-answered close-ended questions, was conducted at 6 different post-graduate centers in Karachi, Pakistan.ResultsOf the 82 participants, 23 (28%) were consultant surgeons while 59 (72%) were general surgery residents. 86% of participants were aware that stones lost during LC can cause complications. Out of the 18 reported complications presented, only 20% participants identified more than 8 complications for which they can consider lost gallstones causal. 28% of participants weren’t aware about the expected postoperative duration for presentation of complications. Only 15% of our participants expected complications beyond 5 years of the procedure. 72% of participants will not convert to open cholecystectomy to retrieve lost gallstones. While 88% of participants agreed that lost gallstones should be documented in operative notes, only 70% reported that it’s actually done in practice. 55% of participants agreed to have possibility of lost gallstones as part of the informed consent but in practice it’s included according to only 31% of participants. 68% of participants believe that patients should be informed if gallstones are lost but in actual practice only 41% participants inform patients when gallstones are lost during procedure.ConclusionsWe conclude that there is a dearth of awareness regarding diversity of complications from lost gallstones and about their variable postoperative duration of presentation. The practices involving lost gallstones management, documentation and patient information were found to vary widely. Proper awareness is imperative as it may compel surgeons to undertake all possible measures to retrieve spilled gallstones and progress towards better and standardized practices in managing lost gallstones.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey

et al. 2013

View full text Add to dashboard Cite

show abstract

“…The UK Healthcare Commission has advised one group of surgeons 16 that the risk and possible complications of spilled gallstones should be part of informed consent and that if this does occur and the stones are not retrieved, the patient and their general practitioner should be informed.…”

Section: Other Complicationsmentioning

confidence: 99%

Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland

Scurr

Brigstocke

Shields

et al. 2010

annals

View full text Add to dashboard Cite

INTRODUCTION The causes and outcomes of medicolegal claims following laparoscopic cholecystectomy were evaluated. SUBJECTS AND METHODS A retrospective analysis of the experience of a consultant surgeon acting as an expert witness within the UK and Ireland (1990-2007). RESULTS A total of 151 claims were referred for an opinion. Sixty-three related to bile duct injuries and four followed major vascular injury. Bowel injury resulted in 17 claims. A postoperative biliary leak not associated with a bile duct injury was responsible for 25 claims. Other reasons for claims included spilled gallstones, port-site herniae, haemorrhage and other recognised complications associated with laparoscopic cholecystectomy. Twelve of the claims are on-going, two went to trial, 79 (52%) were settled out of court and 58 (38%) were discontinued after the claimants were advised that they were unlikely to win their case. Disclosed settlement amounts are reported. CONCLUSIONS Bile duct and major vascular injuries are almost indefensible. The delay in diagnosis and (mis)management of other recognised complications following laparoscopic cholecystectomy have also led to a significant number of successful medicolegal claims.

show abstract

“…As with spilt gallstones,5 every effort must be made to identify and retrieve appendicoliths at the index operation. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage.…”

Section: Discussionmentioning

confidence: 99%

Shortness of breath, fever and abdominal pain in a 21-year-old student

et al. 2013

View full text Add to dashboard Cite

SUMMARYA 21-year-old patient presented with a 3-day history of shortness of breath, productive cough, fatigue, fevers and night sweats, associated with right upper quadrant pain. He had an appendicectomy 3 months previously. The CT images showed a right subphrenic collection, which was indenting the right lobe of the liver, with an appendicolith in the middle. He underwent laparoscopic surgery where the abscess was drained and the appendicolith was retrieved. The patient had an uncomplicated postoperative period and was discharged soon afterwards. Complications from spilled appendicoliths have been reported previously. Retained appendicoliths and gallstones can act as niduses for infection, and thus cause symptoms at a later stage. Surgical notes should include the findings of appendicoliths, and in the event where retrieval is not possible, a clear record of this must be made, and the patient along with the general practitioner need to be informed. BACKGROUND

show abstract

The Case for Standardisation of the Management of Gallstones Spilled and not Retrieved at Laparoscopic Cholecystectomy

Cited by 25 publications

References 5 publications

Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey

Knowledge and practices of general surgeons and residents regarding spilled gallstones lost during laparoscopic cholecystectomy: a cross sectional survey

Medicolegal claims following laparoscopic cholecystectomy in the UK and Ireland

Shortness of breath, fever and abdominal pain in a 21-year-old student

Contact Info

Product

Resources

About