Dropped gallstones during laparoscopic cholecystectomy : The consequences

During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current dis...

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Bibliographic Details
Published in:World journal of surgery 2005-04, Vol.29 (4), p.437-440
Main Authors: TURNER, Ali Riza, YÜKSEK, Yunus Nadi, YASTI, Ahmet Cinar, GÖZALAN, Ugur, KAMA, Nuri Aydin
Format: Article
Language:English
Subjects:
Abdominal Abscess - diagnostic imaging
Abdominal Abscess - etiology
Biological and medical sciences
Cholecystectomy, Laparoscopic - adverse effects
Cholecystolithiasis - surgery
Gallbladder - injuries
Gastroenterology. Liver. Pancreas. Abdomen
General aspects
Humans
Intraoperative Complications
Laparotomy
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Other diseases. Semiology
Tomography, X-Ray Computed
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Summary:During laparoscopic cholecystectomy, gallbladder perforation has been reported, leading to bile leak and spillage of gallstones into the peritoneum. Because the consequences can be dangerous, conversion to laparotomy as an instant management for gallstone spillage is one of the topics of current discussion in laparoscopic cholesystectomy. In this article, we discussed the option of not converting to laparotomy after intraperitoneal gallstone spillage as an acceptable approach to management or not.A prospectively maintained database of 1528 consecutive laparoscopic cholecystectomies performed during a 10-year period at the 4th Surgical Clinic of The Ankara Numune Education and Research Hospital was analyzed. Perforations resulting in gallstone spillage into the abdominal cavity were documented in 58 (3.8%) patients. Among those 58 patients seven (12%) experienced complications from retained stones. To maintain acceptable management of such patients, surgeons should inform each patient preoperatively that stones may be spilled. In the event of spillage, the patient should be informed postoperatively, and followed closely for complications. Follow-up should not waste time and money with unnecessary examinations, and it should avoid psychological trauma to the patient with a wrong diagnosis of cancer as a stone may mimic cancer radiologically. Thus the surgeon should not hesitate to record the events and inform the patient about the spillage of the stones and possible consequences.
ISSN:0364-2313
1432-2323
DOI:10.1007/s00268-004-7588-9