Abstract
Background: Gallbladder perforation, with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy. Recent publications report complications in port sites or in the abdominal cavity. A study of 3686 laparsocopic cholecystectomies performed by 6 surgeons was undertaken. In 627 patients, perforation of the gallbladder occurred and in 254 stones were spilled into the abdominal cavity. In 214 they were retrieved and in 40 left in the abdomen. Twelve patients developed complications. Percutaneous drainage was successful in 2 with serous collections. Two patients with abdominal abscesses were reoperated, stones retrieved and the abdomen drained. One patient developed an intestinal obstruction due to a stone in the ileum. One patient who had a cholecystectomy in another hospital developed a paraumbilical tumor. At reoperation a stone was retrieved. In another six patients, stones were found in port sites. Stones lost into the abdomen should be removed because of their potential morbidity, especially if they are large or if infection is present in the gallbladder at the time of initial surgery. There is no indication for routine conversion to open surgery when stone spillage occurs, although patients should be informed to avoid legal consequence, and to hasten early diagnosis of later complications.
Highlights
Gallbladder disruption with stones falling into the peritoneal cavity was rare during open cholecystectomy, but is frequent in laparoscopic cholecystectomy
Perforation of the gallbladder occurred in 627 cases (17%) and in 254 (6.9%) stones spilled into the abdominal cavity
Perforation of the gallbladder with bile and calculi falling into the abdomen is common in Intraabdominal stones (n 5) Treatment Percutaneous drainage 2 Surgical drainage of abdominal abscess and recovery of stones 2 Operation for ileal obstruction
Summary
Gallbladder disruption with stones falling into the peritoneal cavity was rare during open cholecystectomy, but is frequent in laparoscopic cholecystectomy. Retrieval of stones is difficult during laparoscopic cholecystectomy. Reports on laparoscopic cholecystectomy stated that stones, left in the peritoneal cavity, had no deleterious effect [26, 31]. More recently as a consequence of spilled stones sepsis, adhesions and fistulae into abdominal organs or port tracts have been described [3, 6, 8, 14, 15]. Gallbladder perforation, with loss of calculi in the abdomen is frequent during laparoscopic cholecystectomy. Recent publications report complications in port sites or in the abdominal cavity. In 627 patients, perforation of the gallbladder occurred and in 254 stones were spilled into the abdominal cavity. Two patients with abdominal abscesses were reoperated, stones retrieved and the abdomen drained
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