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10- SPILLED GALL STONES DURING LAPAROSCOPIC CHOLECYSTECTOMY : A PROSPECTIVE STUDY

Mushtaq Ch. Abu-Alhail --- Mazin A Abdulla --- Jasim D Saud

Basrah Journal of Surgery مجلة البصرة الجراحية
ISSN: 16833589 Year: 2011 Volume: 17 Issue: 1 Pages: 65
Publisher: Basrah University جامعة البصرة

Abstract

Jasim D Saud#, Mazin A Abdulla@ & Mushtaq Ch. Abu-Alhail**#MBChB, CABS, Specialist Surgeon, Basrah General Hospital, Basrah, Iraq. @MBChB, CABS,Consultant Surgeon, Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq.ABSTRACTThis study assesses the impact of spilled gall stones during laparoscopic cholecystectomy (LC)and it's clinically significant complications resulting from stones left in the peritoneum.This is a prospective analysis of laparoscopic cholecystectomies performed at The SurgicalUnit in Basrah General Hospital from 1st January 2006 to 31st December 2010. There were 678patients in the study who underwent LC. The inclusion criteria for LC were: patients of all agesand both genders, symptomatic gallstone disease, recurrent attack while waiting for interval LC,normal values of blood complete picture & liver function tests and ultrasound examination ofabdomen demonstrating gallstone disease.There were 73 cases of gallbladder perforation, i.e. a frequency of 10.7%. In 34 of thesepatients gallstones spillage also occurred in a frequency of 5%. An effort was made in eachcase to remove the spilled stones laparoscopically but in 25 patients unretrieved stones wereleft (frequency of 3.6%). Eight patients (1.17%) developed complications, one patient developedileus which was thought to be the result of irritation from a gallstone that had been shown on USexamination. The free fluid in the Douglas pouch resolved with medical management. Twopatients developed sub-hepatic abscess, presenting with right hypochondrial & shoulder tip painand fever post operatively; which confirmed by abdominal sonograph, one patient respondedwell to medical treatment while the other one required ultrasound guided drainage and broadspectrumantibiotics. Three patients developed epigastric port site infection; two were treatedsuccessfully by daily wound care and appropriate antibiotics after culture and sensitivity. Onedeveloped persistent epigastric sinus, and a gallstone was retrieved on exploration. Twopatients developed sub-hepatic and right sub-phrenic abscess respectively in the seventh postoperative day and required open drainage. There was no mortality and long-term morbidity.In conclusion, complications arising from spillage of gall stones during laparoscopiccholecystectomy are rare. They can present months after the cholecystectomy with septiccomplications. The patients should be informed preoperatively that spillage of bile andgallstones are possible. The surgeon should take utmost care to prevent spillage of stones andattempt to remove all visible stones at the time of surgery. If spillage occurred it should berecorded clearly in the operative notes and such patients should be kept under close follow upto aid in the early diagnosis of later complications. There is no indication for routine conversionto open surgery.

Keywords

SPILLED --- GALL STONES LAPAROSCOPIC --- CHOLECYSTECTOMY