Gallstone Spillage Research Articles

Critical view of safety (cvs) in laparoscopic cholecystectomy; what if you fail to establish?

Background: Concept of establishing Critical View of Safety is currently recommended in Laparoscopic Cholecystectomy (LC) to minimize iatrogenic bile duct injuries. Methods: A prospective analysis was done on 72 consecutive LCs from April 2016 to January 2017 in a surgical unit at National Hospital of Sri Lanka. The hepatocystic triangle was dissected to establish CVS. Photo documentation of CVS was done prior to division of cystic duct and artery in each case. Retrograde dissection was performed when establishing CVS was difficult. Results: Out of 72 cases 53(73.6%) were females. Mean age was 48(range: 21-79) years. CVS was established in 55(76.3%) cases which included 3 empyemas, 5 mucocoeles, 3 acute cholecystitis and 14 chronic cholecystitis. Mean time for establishing CVS was 35.9(±16.2) minutes. Fibrosis and adhesions in hepatocystic triangle (64.7%) and doubtful anatomy (17.6%) were the commonest reasons for not establishing CVS. Three underwent subtotal cholecystectomy including one case of Mirizzi syndrome. Bile spillage (19.4%) & gallstone spillage (9.7%) were the commonest complications. Majority (92.1%) were discharged within 48 hours. None had bile duct injuries. Conversion and Mortality rates were zero. Conclusion: Establishing CVS is recommended as the starting point of dissection in LC. However if CVS is not established timely decision on retrograde dissection with appreciation of variable biliary anatomy will minimize the risk of iatrogenic bile duct injuries as well as conversion to open procedure.

Bile Granuloma Mimicking Peritoneal Seeding: A Case Report.

Laparoscopic cholecystectomy is a widely used treatment method for most cholelithiasis and is a relatively safe procedure. Foreign body granulomatous reaction to bile or gallstone spillage during laparoscopic cholecystectomy has rarely been reported. We report a case of bile granuloma after laparoscopic cholecystectomy, which mimicked peritoneal seeding. A 59-year-old Korean man presented with right upper quadrant pain. He underwent laparoscopic cholecystectomy for acute cholecystitis with cholelithiasis. Pathologic examination revealed an incidental adenocarcinoma invading the lamina propria with acute cholecystitis and cholelithiasis. After 3 months, follow-up abdominal computed tomography revealed a subhepatic nodule, which showed hypermetabolism on positron emission tomography–computed tomography. Suspecting localized peritoneal seeding, wedge resection of the liver, wedge resection of the transverse colon, and omentectomy were performed. Pathologic examination of the resected specimens revealed multiple bile granulomas. Awareness of bile granuloma mimicking malignancy is noteworthy for patient management to reduce unnecessary procedure during postoperative surveillance.

Incidence of Superficial Port Site Infection in Laparoscopic Cholecystectomy in relation to Spilt Stone and Bile Spillage

Introduction: Laparoscopic cholecystectomy is the choice of operation for symptomatic gallstones. Gallstone and bile spillage can occur during laparoscopic cholecystectomy during dissection by cautery or due to perforation of gall bladder by grasper. The complication of spilt stone and bile may range from simple superficial surgical site infection, adhesion, obstruction, abscess formation to none.
 Methods: This study was conducted at Western Regional Hospital (WRH), Pokhara from July 2015 to December 2016. A total of one hundred and twenty patients who underwent laparoscopic cholecystectomy were included. All patients’ age, sex, pre-operative ultrasound findings, intra operative spillage of stone and bile and post-operative superficial surgical site infection were noted. Statistical analysis was done using Microsoft Excel software and SPSS-21. Result obtained from the study was discussed with reference to current world literature.
 Results: Out of one hundred and twenty patients, one hundred and nine were female and eleven were male with mean age of 42.68 years. Spillage of stones and bile occurred in twelve patients (10%). Spillage of stone and bile was common with multiple stones. Only four patients (one male and three females) developed superficial port site infection (3.3%). Two patients among spillage and two among non spillage developed superficial surgical site infection (p<0.05). Most common organism was Staphylococcus aureus followed by Escherichia coli.
 Conclusion: The incidence of split stone or bile is 10 % and is common with multiple gallstones. The chance of superficial surgical site infection is more in male patients and with spillage of stone and bile.

Incidence of major biliary injuries associated with laparoscopic cholecystectomy at Al-Karama teaching hospital, Baghdad, Iraq

Background: Laparoscopic cholecystectomy (LC), is a new modality of surgery late surfaced late 1980s. Compared with open cholecystectomy, LC is associated with less local pain, shorter hospitalization resulting in an early return to work, and a favourable cosmetic outcome. The aim of this study was to determine the incidence of major biliary injuries associated with LC.Methods: The patients have been admitted before operation and classical LC was done. Monopolar electrocautery was used. The insertion of postoperative intraperitoneal drain or nasogastric tube depended on the surgeons' preference and opinion. The data was evaluated according to outcome measures, such as bile duct injury, morbidity, mortality and numbers of patients whose operations had to be converted from laparoscopic to open.Results: One hundred and eighty-three (183) patients were initially included in this study. LC was accomplished successfully in one hundred and sixty-two patients (162), twenty-one have been converted to the conventional open method due to sever adhesions or unclear anatomy and they were excluded from this study. Among those who underwent LC, 5(2.73%) had major biliary injuries, another 6 (3.28) had minor injuries and 7 (3.82%) Spillage of Gallstones to the Peritoneal cavity.Conclusions: Biliary injury is the Achilles’ heel of laparoscopic Cholecystectomy. It can have devastating effects, turning the individual into a "biliary cripple". They mainly result from anatomical anomalies and errors of human judgment and are thus preventable to some extent.

The lost stone — Laparoscopic exploration of abscess cavity and retrieval of lost gallstone post cholecystectomy: A case series and review of the literature

BackgroundLaparoscopic cholecystectomy (LC) is considered the gold standard operation for symptomatic gallstones. Gallbladder perforation occurs in 6–40% of operations. It can lead to spillage of gallstones into the abdominal cavity with possible consequences of long-term complications. We report two cases where a unique use of laparoscopic technique was used to explore abscess cavity and retrieve lost gallstones without penetrating the peritoneal cavity. Case presentationWe report two cases of peri-hepatic abscess treated with laparoscopic cavity exploration, using 5 mm and 10 mm ports, to retrieve lost gallstones. It was done without entering the peritoneal cavity. DiscussionToday, minimally invasive technique is used in a variety of surgical cases. We report a novel technique, using laparoscopic skills, to drain abscesses caused by lost gallstones post LC without entering the peritoneal cavity. The use of minimally invasive surgery techniques in order to explore abscess cavities not only help us to extract the cause of the abscess but also prevents another surgery in the abdominal cavity. ConclusionLaparoscopic exploration of an abscess cavity is a feasible and safe technique treating long-term complications of gallbladder perforation post LC.

Spontaneous Discharge of Spilled Gallstones Following Laparoscopic Cholecystectomy

Spontaneous Discharge of Spilled Gallstones Following Laparoscopic Cholecystectomy

Peritoneo-cutaneous fistula from spilled gall bladder calculus following laparoscopic cholecystectomy.

Key Clinical MessageInadvertent spillage of gall stones is a rare yet important cause of delayed postcholecystectomy complications. Varied presentations and difficulty in diagnosis are the hallmarks, making it crucial to have a high index of suspicion to detect and intervene appropriately. Peritoneo‐cutaneous fistulae from the retained stone can be completely excised in toto.

Dropped Gallstones: A Case of Persistent Right Flank Abscess Requiring Surgical Management

Gallstone spillage is not an uncommon occurrence during laparoscopic cholecystectomy. Once thought to be harmless, the consequences of dropped gallstones, including intra-abdominal abscess, are now recognized as a cause of significant morbidity. Additionally, patients with complications due to such an event may have delayed diagnosis due to remote, unusual presentation and failure of imaging to detect the gallstones. We report the case of a patient who presented with recurrent right flank abscesses. The patient presented multiple times and improved symptomatically with IV antibiotics and percutaneous drainage. However, each time his symptoms returned within 2 weeks of discharge.

Glissonian Capsule Fistula after Laparoscopic Cholecystectomy

Abstract Background: Perforated gallbladder is a common complication during laparoscopic cholecystectomy. Although morbidity is rare, serious complications can manifest subsequently. Patients may suffer long-term complications and laparotomy has been suggested to some for symptom relief. Patients and Methods: We present a case of laparoscopic cholecystectomy that was complicated by gallstone spillage. The patient presented later with a fistula, connecting the Glisson capsule to the subxiphoid trocar scar. Laparoscopic resection of the fistulous tract was recommended to the patient. Results: The post-operative course was uneventful and the patient remained asymptomatic 12 months after the procedure. Conclusion: Perforated gallbladder is a common complication during laparoscopic cholecystectomy and patients may suffer long-term complications. Some have had laparotomy recommended for symptom relief. However, recent research could not determine the best treatment modality. We have offered re-laparoscopy with ...

Clipless harmonic scalpel assisted cholecystectomy versus conventional laproscopic cholecystectomy

Introduction: Laproscopic cholecystectomy is gold standard in the management of symptomatic gallstone disease. Ultrasonically activated scalpel has come up as alternative to traditional electrocautery for haemostatic dissection of tissues. Little research has been done to compare effectiveness of conventional laproscopic cholecystectomy and harmonic cholecystectomy. Aim and objective: To compare conventional laproscopic cholecystectomy versus clipless harmonic scalpel assisted cholecystectomy among the patients undergoing laproscopic cholecystectomy for symptomatic cholelithiasis at IGMC Shimla. Materials and method: Prospective study involved 400 patients operated for symptomatic cholelithiasis. Patients were divided into two groups of 200 patients each.Group A was control group who underwent conventional laproscopic cholecystectomy and Group B who underwent laproscopic cholecystectomy with harmonic scalpel. Results: In group A mean duration of surgery was 43 min and 20 seconds while in group B it was 30 min and 40 sec. In terms of intraoperative complications in group A gallbladder perforation was seen in 48 patients while in group B in 8 patients, while spillage of gall stones was seen in 48 patients in Group A it was seen in 8 patients in group B. Mean blood loss in group A was 19.72 cc while in group B it was 13.18 cc. Mean time interval of rescue with analgesic for post operative pain in group A was 7.64 while in group B was 8.72. Conclusion: Present study clearly establishes that harmonic laproscopic cholecystectomy is a safe alternative to conventional laproscopic cholecystectomy with short hospital stay, less postoperative pain, early recovery and comparable complication rate.

Dropped gall stones: an entity in evolution

Laparoscopic cholecystectomy is the gold standard for treating calculous cholecystitis. Many a times the procedure may be associated with rupture of the gall bladder and spillage of gall stones and sludge into the peritoneal cavity. The complication of spilled or dropped gall stones in the peritoneal cavity is not fully documented. This is because majority of the cases go unreported. The possible natural history and management of dropped gall stones is discussed in this article.

Abdominal Wall Abscess Harbouring Gall Stones and Adenocarcinoma after Laparoscopic Cholecystectomy: A Rare Case Report

Cholecystectomy is the most commonly performed operation worldwide. Laparoscopic cholecystectomy is the gold standard treatment of gall stones today. Over the decades the complications of laparoscopic cholecystectomy has decreased but gall bladder perforation and bile spillage is still a significant problem. The lost gall stones can lead to abscess formation both intra-abdominal and intraparietal. Rarely the port sites may harbor malignancy, which is the most feared of all complications. So gall bladder perforation and bile or gall stone spillage should be properly documented.

Necrotizing Soft Tissue Infection Caused by Spilled Gallstones

We report a case of a 57-year-old woman who presented with a necrotizing soft tissue infection of the right anterior abdominal wall, 1 year after open cholecystectomy for gallbladder perforation. Surgical exploration revealed pigmented gallstones along with pus in the abdominal wall and gallbladder fossa. Intraoperative spillage of gallstones is common during both open and laparoscopic cholecystectomy, but, in rare cases, can lead to serious complications including necrotizing infection of the abdominal wall.

Retained abdominal gallstones after laparoscopic cholecystectomy: a systematic review.

The aim of this study is to make a systematic review of high-quality published trails regarding the complications of retained gallstones after laparoscopic cholecystectomy for cholelitiasis. Medline search from 1987 to 2013 was done. Nine studies with >500 LCs which reported retained gallstones and perforated gallbladders were analyzed systematically. Of 536 listed reports including case reports, clinical trials, reviews, journal articles, and meta-analytic reports; 9 studies each reporting >500 LCs which reported the incidence of perforated gallbladders and spilled stones were found. The number of operations, the number of perforated gallbladders, the number of patients who had gallstone spillage, and the postoperative complications were searched in these studies and the strongest and weakest aspects of the articles were discussed. Retained abdominal gallstones can cause various postoperative problems including extra-abdominal complications. In case of perforation of the gallbladder during laparoscopic cholecystectomy, spilled gallstones should be collected to prevent further complications but conversion to open surgery is not mandatory.

Dropped Gallstones Causing a Perihepatic Abscess and Empyema.

Iatrogenic perforation of the gallbladder during laparoscopic cholecystectomy is a well-known occurrence; however, the consequences of spillage of gallstones in the peritoneum and particularly intrathoracic complications are less defined. We describe the delayed development of a perihepatic abscess and empyema in a patient five years following laparoscopic cholecystectomy secondary to dropped gallstones. A 53-year-old man with medical history significant for a laparoscopic cholecystectomy five years prior to acute cholecystitis presented with purulent cough, hemoptysis, night sweats, and right-upper quadrant (RUQ) pain. Computed tomography (CT) scan revealed 5.4 cm right-sided subpulmonic and 5.9 cm perihepatic fluid collections with an 8 mm focal radiopaque density within the perihepatic fluid collection. Open intra-abdominal exploration resulted in retrieval of a 1 cm intraperitoneal gallstone. Laparoscopic cholecystectomy is a common surgical operation during which gallstone spillage can occur, causing both intra-abdominal and intrathoracic complications, presenting even years after surgery. This necessitates an attempt to retrieve all free intra-abdominal gallstones during the initial operation.

腹腔鏡下胆囊摘出術時の腹腔内落下結石による右横隔膜下肉芽腫の１例

腹腔鏡下胆囊摘出術時の腹腔内落下結石による右横隔膜下肉芽腫の１例

Attitudes and Practices of Surgeons towards Spilled Gallstones during Laparoscopic Cholecystectomy: An Observational Study.

The sequelae of spilled gallstones after Laparoscopic cholecystectomy (LC) and the occurring complications may go unnoticed for a long time and can be a diagnostic challenge. The aim of this survey was to study the knowledge, attitude, and practices of surgeons regarding spilled gallstones during LC. An observational, cross-sectional survey, using a questionnaire based on 11 self-answered close-ended questions, was conducted among general surgeons. Of the 138 respondents only 29.7% had observed a complication related to gallstone spillage during LC. There was varied opinion of surgeons regarding management of spilled gallstones, documenting the same in operative notes and consent. It was observed that there is lack of knowledge regarding the complications related to gallstone spillage during LC. There is need to educate surgeons regarding safe practices during LC to avoid gallstone spillage, early diagnosis, and management of complications. There is need to standardize practice to retrieve lost gallstones to reduce complication and legal consequences.

Data conflicts: the dwindling power of a study.

I have read the article “Consequences of spilled gallstones during laparoscopic cholecystectomy (LC)” by Suvi Virupaksha [1] with interest. The unpredictable outcome of spilled gallstones that are left un-retrieved during LC is often a cause of future embarrassment for the operating surgeon. So, it comes as a surprise that most instances of unrecovered spilled gallstones are neither documented in the operation notes nor disclosed to the patients. This prospective observational study was carried out in 150 (1 gallbladder polyp, 2 acalculous cholecystitis, and 147 gallstones) patients of LC over a period of one year. There are many glaring inconsistencies in the presented data that merit clarification by the author. The table outlining the ultrasound findings mentioned of 10 patients with solitary gallstone while multiple stones were detected in 135 patients. This amounts to a total of 145 instead of 147 patients with gallstone disease. Similarly, the sum total of patients of the three different groups categorized on the basis of stone size is 156 instead of 147. The author has variably reported the incidence of gallstone spillage in this article (19.04 % in the text and 18.91 % in the table). All the instances of gallstone spillage in this series were secondary to gallbladder perforations, but in the table comparing the results of the present study with international data, the reported incidence of spillage is more than that of gallbladder perforation. The various mechanisms responsible for gallbladder perforation are detailed in a tabular form; however, the numbers mentioned against different mechanisms are quite confusing as they are neither adding up to the total number of patients nor to the percentage of patients with spilled stones. The author has boasted of zero percent incidence of un-retrieved gallstones, but at the same time, mentioned of a patient with port-site wound complication secondary to a left out gallstone in the subcutaneous plane. The author could have analyzed the incidence of spilled stones in relation to the incidence of complicated gallstone disease, aberrant ultrasound findings, and abnormal histopathological reports to predict risk factors for gallbladder perforation and stone spillage. Mention of any special effort made to locate and retrieve the spilled stones during LC, any change in the duration of postoperative antibiotics to counteract the increased risk of infective complications consequent to intraoperative spillage of bile and stones would have been immensely beneficial to the numerous readers keen on mastering the art of this common laparoscopic procedure. The author has summarized the study with a list of suggestions to reduce the rate of stone spillage during LC. Few other additions to this list can be as follows: secure grasping of the neck of the excised gallbladder along with the cystic duct clip during extraction, adequate enlargement of the port site for smooth extrication followed by meticulous examination of the retrieved specimen for integrity of the gallbladder wall. Any defect in the wall should prompt repeat inspection of all the relevant intra-peritoneal recesses as well as the path of extrication of the gallbladder.

Pictorial review of complications related to spilled gall stones following cholecystectomy

Purpose: Complications related to spilled gall stones can happen many years after the surgery in the form of recurrent abdominal or anterior abdominal wall abscesses. This poster aims to educate the delegates to think of this possibility and to look carefully for the spilled gall stones within the abscess collection.

Lost gallstones mimicking a gastric pylorus tumour

Lost gallstones after laparoscopic cholecystectomy is a frequent occurrence. We describe a case report of an unusual delayed presentation of the above condition and discuss the published literature on this topic. Prevention of gallstone spillage and retrieval of all the spilled gallstones remain the best methods of avoiding future potential morbidity.