The fate of the dropped gallstones during laparoscopic cholecystectomy

Abstract

Stones can be spilled from the gallbladder during laparoscopic cholecystectomy. These stones can be left in the peritoneal cavity or trapped at the trocar site. The potential late sequel and associated morbidity are not well documented. We reviewed the records of four patients who underwent laparoscopic cholecystectomy at Mount Sinai Medical Center in New York City who suffered from late complications attributed to gallstones left in the peritoneal cavity or abdominal wall. Four patients presented 1-14 months after laparoscopic cholecystectomy with intraabdominal and abdominal wall abscesses. The spillage of gallstones was noticed during the initial operation only in one of the patients. Three patients required laparotomy and open drainage of intraabdominal abscesses with drainage of pus and gallstones after failed attempts at percutaneous drainage. Two patients underwent local exploration of an abdominal wall abscess containing stones. Stones left in the abdominal cavity or trapped in trocar sites after laparoscopic cholecystectomy can cause serious late complications requiring repeated surgical interventions. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder and cystic duct and during retrieval of the gallbladder through the abdominal wall.

Peritoneal gallstones following laparoscopic cholecystectomy

“…Stones removal will usually involve open surgery [39,45,56,58]; however, laparoscopic [26] and thorascopic [3] techniques are occasionally successful in retrieving stones. Percutaneous techniques have also been used to remove stones from subphrenic collections [54] and sinus tracts [33].…”

Laparoscopic Cholecystectomy for Gallstones: A Comparison of Outcome between Acute and Chronic Cholecystitis

“…It has also been suggested that conversion should be considered if a large number of unretrieved stones are split. 33,34,37 Mortality in LC is reported to be less than that in OC. 3 In a review of 114,005 cases from the US, an overall related mortality of 0.06% was reported.…”

“…Cases of lost stones have been reported in up to 40% of LC, 32 but only about 0.08% develop stone-related clinical problems, 33 which include intraperitoneal abscess, cutaneous umbilical sinus, systemic infection, fibrosis, adhesions, fistulas and migration to other sides. [32][33][34][35][36][37][38] We had no problems with the 3.3% missed stones. In OC, it is less of a problem because they can be retrieved more easily.…”

“…10,34,37 A large survey from the UK reported that only 17.9% of 396 surgeons who performed LC found it mandatory to retrieve split stones. 39 Certain steps are suggested if perforation occurs.…”

Gall Stone S Retrevial During Laproscopic Cholecystectomy

“…Some reports, like Brueggemeyer et al, 12 demonstrated that spillage of gallstones can cause intra peritoneal abscess. Zamir et al 13 reported similar findings.…”