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Peritoneal gallstones following laparoscopic cholecystectomy

Incidence, complications, and management

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Abstract

Background:

Gallstone spillage during laparoscopic cholecystectomy (LC) is a common intraoperative event. Although gallstones left in the peritoneal cavity were initially considered harmless, a significant number of complications have been reported. Our aim was to quantify the likelihood, and to document the range, of subsequent complications.

Methods:

A Medline search from 1987 to January 2003 was performed. Articles with more than 500 LCs that quantified the frequency of complications due to peritoneal gallstones were reviewed, as were representative case studies of different stated complications.

Results:

Six studies, covering 18,280 LCs, were found. The incidence of gallbladder perforation was 18.3%, that of gallstone spillage was 7.3%, and that of unretrieved peritoneal gallstones was estimated to be 2.4%. There were 27 patients with complications. The likelihood of a complication when gallstone spillage occurred was 2.3%, which increased to 7.0% when unretrieved peritoneal gallstones were documented.

Conclusion:

Spilt gallstones have a small but quantifiably real risk of causing a wide range of significant postoperative problems.

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References

  1. Y Assaff I Matter E Sabo JG Mogilner E Nash J Abrahamson S Eldar (1998) ArticleTitleLaparoscopic cholecystectomy for acute cholecystitis and the consequences of gallbladder perforation, bile spillage, and “loss” of stones Eur J Surg 164 425–431 Occurrence Handle10.1080/110241598750004238 Occurrence Handle1:STN:280:DyaK1czlvFKgsA%3D%3D Occurrence Handle9696443

    Article  CAS  PubMed  Google Scholar 

  2. JP Bonar MW Bowyer DR Welling K Hirsch (1998) ArticleTitleThe fate of retained gallstones following laparoscopic cholecystectomy in a prairie dog model J Soc Leparoendosc Surgeons 2 263–268 Occurrence Handle1:STN:280:DyaK1M%2FpsVSgsw%3D%3D

    CAS  Google Scholar 

  3. SA Brazinsky GC Henri (1993) ArticleTitleThorascopic diagnosis of pleurolithiasis after laparoscopic cholecystectomy Chest 104 1273–1274 Occurrence Handle1:STN:280:ByuD3cfhsVQ%3D Occurrence Handle8404206

    CAS  PubMed  Google Scholar 

  4. JG Brockmann T Kocher NJ Senninger GM Schurmann (2002) ArticleTitleComplications due to gallstones lost during laparoscopic cholecystectomy An analysis of incidence, clinical course, and management. Surg Endosc 16 1226–1232

    Google Scholar 

  5. MT Brueggemeyer AK Saba LC Thibodeaux (1997) ArticleTitleAbscess formation following spilled gallstones during laparoscopic cholecystectomy J Soc Laparoendosc Surgeons 1 145–152 Occurrence Handle1:STN:280:DyaK1M%2Fptl2nsQ%3D%3D

    CAS  Google Scholar 

  6. JKS Chia R Martin T Calif (1995) ArticleTitleGallstones exiting the urinary baldder: a complication of laparoscopic cholecystectomy Arch Surg 130 677 Occurrence Handle1:STN:280:ByqB1czks1c%3D Occurrence Handle7763182

    CAS  PubMed  Google Scholar 

  7. PT Chin S Boland JP Percy (1997) ArticleTitle“Gallstone hip” and other sequelae of retained gallstones HPB Surg 10 165–168 Occurrence Handle1:STN:280:ByiA3Mjosl0%3D Occurrence Handle9174862

    CAS  PubMed  Google Scholar 

  8. RV Cohen PRB Pererira MV Barros (1994) ArticleTitleIs the retrieval of lost peritoneal gallstones worthwhile? Surg Endosc 8 1360 Occurrence Handle10.1007/BF00188305 Occurrence Handle1:STN:280:ByqC3s3pvVI%3D Occurrence Handle7831618

    Article  CAS  PubMed  Google Scholar 

  9. SN Cullis PC Jeffery G McLauchlan PC Bornman (1992) ArticleTitleIntraperitoneal abscess after laparoscopic cholecystectomy Surg Laparosc Endosc 2 337–338 Occurrence Handle1:STN:280:ByuD1c%2Fls1w%3D Occurrence Handle1341558

    CAS  PubMed  Google Scholar 

  10. F Daoud AM Awwad J Masad (2001) ArticleTitleColovescial fistula due to a lost gallstone following laparoscopic cholecystectomy: report of a case Surg Today 31 255–277 Occurrence Handle10.1007/s005950170181 Occurrence Handle1:STN:280:DC%2BD3MvjsV2iuw%3D%3D Occurrence Handle11318133

    Article  CAS  PubMed  Google Scholar 

  11. J Diez C Arozamena L Gutierrez J Bracco A Mon R Sanchez Almeyra M Secchi (1998) ArticleTitleLost stones during laparoscopic cholecystectomy HPB Surg 11 105–109 Occurrence Handle1:STN:280:DyaK1M7gvFWiug%3D%3D Occurrence Handle9893240

    CAS  PubMed  Google Scholar 

  12. Z Dreznik NJ Soper (1993) ArticleTitleTrocar site abscess due to spilled gallstones: an unusual late complication of laparoscopic cholecystectomy Surg Laparosc Endosc 3 223–224 Occurrence Handle1:STN:280:ByuC2MvpsFM%3D Occurrence Handle8111563

    CAS  PubMed  Google Scholar 

  13. C Famularli G Pirrone A Macri F Crescenti G Scuderi G DeCaridi AL Giuseppe (2001) ArticleTitleThe vesical granuloma: rare and late complication of laparoscopic cholecystectomy Surg Laparosc Endosc Percutan Tech 11 368–371 Occurrence Handle10.1097/00019509-200112000-00006 Occurrence Handle11822861

    Article  PubMed  Google Scholar 

  14. AN Freedman HH Sigman (1995) ArticleTitleIncarcerated paraumbilical incisional hernia and abscess—complications of a spilled gallstone J Laparoendosc Surg 5 189–191 Occurrence Handle1:STN:280:BymD3Mfjt1I%3D Occurrence Handle7548994

    CAS  PubMed  Google Scholar 

  15. RN Gallinaro FB Miller (1994) ArticleTitleThe lost gallstone Complication after laparoscopic cholecystectomy. Surg Endosc 8 913–914 Occurrence Handle1:STN:280:ByqD1cvivVc%3D

    CAS  Google Scholar 

  16. SJ Gosselink-Jongen KJ Bongers BD Westerveld HB Rethmeier (1999) ArticleTitle“Tubalithiasis”; a late complication of laparoscopic cholecystectomy with stone spillage Eur J Surg 165 169–170 Occurrence Handle10.1080/110241599750007397 Occurrence Handle1:STN:280:DyaK1M3gs1Oqtw%3D%3D Occurrence Handle10192577

    Article  CAS  PubMed  Google Scholar 

  17. Y Groebli D Hebert P Tschantz (1998) ArticleTitleThe migrating spilled stone Int Surg 83 31–32 Occurrence Handle1:STN:280:DyaK1czntFyjsA%3D%3D Occurrence Handle9706513

    CAS  PubMed  Google Scholar 

  18. E Gurleyik G Gurleyik O Yucel S Unalmiser (1998) ArticleTitleDoes chemical composition have an influence on the fate of intraperitoneal gallstone in rat? Surg Laparosc Endosc 8 113–116 Occurrence Handle10.1097/00019509-199804000-00006 Occurrence Handle1:STN:280:DyaK1c3is1aitw%3D%3D Occurrence Handle9566563

    Article  CAS  PubMed  Google Scholar 

  19. A Hawasali D Schroder J Rizzo M Thusay T Takach U Thao I Goncharova (2002) ArticleTitleRemote complications of spilled gallstones during laparoscopic cholecystectomy: causes, prevention, and management J Laparoendosc Adv Surg Tech 12 123–127 Occurrence Handle10.1089/10926420252939664

    Article  Google Scholar 

  20. M Horton MG Florence (1998) ArticleTitleUnusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy Am J Surg 175 375–379 Occurrence Handle10.1016/S0002-9610(98)00048-8 Occurrence Handle1:STN:280:DyaK1c3mtV2jug%3D%3D Occurrence Handle9600281

    Article  CAS  PubMed  Google Scholar 

  21. TT Hui DI Giurgiu DR Margulies S Takagi A Iida EH Phillips (1999) ArticleTitleIatrogenic gallbladder perforation during laparoscopic cholecystectomy: etiology and sequelae Am Surg 65 944–948 Occurrence Handle1:STN:280:DyaK1MvktlGlsQ%3D%3D Occurrence Handle10515540

    CAS  PubMed  Google Scholar 

  22. CJ Jost JL Smith RS Smith (2000) ArticleTitleSpontaneous hepatic haemorrhage secondary to retained intraperiotoneal gallstones Am Surg 66 1059–1060 Occurrence Handle1:STN:280:DC%2BD3M%2FmvVCgtw%3D%3D Occurrence Handle11090019

    CAS  PubMed  Google Scholar 

  23. CJ Kelty JA Thorpe (1998) ArticleTitleEmpyema due to spilled stones during laparoscopic cholecystectomy Eur J Cardiothorac Surg 13 107–108 Occurrence Handle10.1016/S1010-7940(97)00262-5 Occurrence Handle1:STN:280:DyaK1c7mtlaksg%3D%3D Occurrence Handle9504742

    Article  CAS  PubMed  Google Scholar 

  24. T Kimura H Goto Y Takeuchi M Yoshida T Kobayashi S Sakuramachi Y Harada (1996) ArticleTitleIntraabdominal contamination after gallbladder perforation during laparoscopic cholecystectomy and its complications Surg Endosc 10 888–891 Occurrence Handle10.1007/s004649900190 Occurrence Handle1:STN:280:ByiC2cjptVU%3D Occurrence Handle8703144

    Article  CAS  PubMed  Google Scholar 

  25. C Klaiber A Metzger C Saager (1992) ArticleTitleThe “shuttle” stone collector—a new device for collecting lost gallstones in laparoscopic cholecystectomy Surg Endosc 6 84 Occurrence Handle1:STN:280:ByuB3cvptVA%3D Occurrence Handle1344590

    CAS  PubMed  Google Scholar 

  26. G Lamvu-Schooler JF Steege (2000) ArticleTitlePostlaparoscopic cholecystectomy pelvic gallstones associated with chronic pain J Am Assoc Gynecol Laparosc 7 273–275 Occurrence Handle1:STN:280:DC%2BD3cvhtVCmsQ%3D%3D Occurrence Handle10806278

    CAS  PubMed  Google Scholar 

  27. MW Law C Hall TH Brown (1996) ArticleTitleBiliary cutaneous fistula; an uncommon complication of retained gallstones following laparoscopic cholecystectomy Surg Laparosc Endosc Percutan Tech 6 150–151 Occurrence Handle10.1097/00019509-199604000-00013

    Article  Google Scholar 

  28. VS Lee EK Paulson E Libby JE Flannery WC Meyers (1993) ArticleTitleCholelithoptysis and cholelithorrhea: rare complications of laparoscopic cholecystectomy Gastroenterology 105 1877–1881 Occurrence Handle1:STN:280:ByuD2svoslY%3D Occurrence Handle8253363

    CAS  PubMed  Google Scholar 

  29. W Lutken P Berggren J Maltbaek (1991) ArticleTitlePassage of gallstone via the urethra: a complication of laparoscopic cholecystectomy Surg Laparosc Endosc 1 246–247 Occurrence Handle1669413

    PubMed  Google Scholar 

  30. MP McDonald JL Munson L Sanders J Tsao J Buyske (1997) ArticleTitleConsequences of lost gallstone Surg Endosc 11 774–777 Occurrence Handle10.1007/s004649900449 Occurrence Handle1:STN:280:ByiA283jsFQ%3D Occurrence Handle9214332

    Article  CAS  PubMed  Google Scholar 

  31. MA Memon RK Deeik TR Maffi RJ Fitzgibbons (1999) ArticleTitleThe outcome of unretrieved gallstones in the peritoneal cavity during laparoscopic cholecystectomy A prospective analysis. Surg Endosc 13 848–857 Occurrence Handle10.1007/s004649901118 Occurrence Handle1:STN:280:DyaK1MzotVKnuw%3D%3D

    Article  CAS  Google Scholar 

  32. R Nicolai RJ Foley (1992) ArticleTitleComplications of spilled gallstones J Laparoendosc Surg 2 362–363 Occurrence Handle1:STN:280:ByyC2cvnvF0%3D Occurrence Handle1490005

    CAS  PubMed  Google Scholar 

  33. EG Ong RM Watkins (1999) ArticleTitleDelayed presentation of spilled gallstones J Laparoendosc Adv Surg Tech A 9 445–447 Occurrence Handle1:STN:280:DyaK1MvltVekuw%3D%3D Occurrence Handle10522544

    CAS  PubMed  Google Scholar 

  34. A Paramesh T Casale R Peralta T Phan S Prakash Y Silva (1998) ArticleTitleTandem subdiaphragmatic and pleural sequelae due to lost gallstones following cholecystectomy J Soc Laparoendosc Surgeons 2 285–288 Occurrence Handle1:STN:280:DyaK1M%2FpsVSgtA%3D%3D

    CAS  Google Scholar 

  35. JH Peters GD Gibbons JT Innes (1991) ArticleTitleComplications of laparoscopic cholecystectomy Surgery 110 769–778 Occurrence Handle1:STN:280:By2D38zgt10%3D Occurrence Handle1833848

    CAS  PubMed  Google Scholar 

  36. F Petit C Vons M Tahrat A Coulomb-L’Hermine F Capron D Franco (1998) ArticleTitleJaundice following laparoscopic cholecystectomy An unusual complication of spilled stones. Surg Endosc 12 450–451 Occurrence Handle10.1007/s004649900702 Occurrence Handle1:STN:280:DyaK1c3ktVKhuw%3D%3D

    Article  CAS  Google Scholar 

  37. J Ponce KE Cutshall MJ Hodge W Browder (1995) ArticleTitleThe lost laparoscopic stone Potential for long-term complications. Arch Surg 130 666–668 Occurrence Handle1:STN:280:ByqB1czksFw%3D

    CAS  Google Scholar 

  38. A Preciado BD Matthews TK Scarborough JL Marti PR Reardon GS Weinstein M Bennett (1999) ArticleTitleTransdiaphragmatic abscess: late thoracic complication of laparoscopic cholecystectomy J Laparoendosc Adv Surg Tech A 9 517–521 Occurrence Handle1:STN:280:DC%2BD3c%2Fps1ektA%3D%3D Occurrence Handle10632515

    CAS  PubMed  Google Scholar 

  39. DC Rice MA Memon RL Jamison T Agnessi D Ilstrup MB Bannon MB Farnell CS Grant MG Sarr GB Thompson JA Heerden Particlevan SP Zietlow JH Donohue (1997) ArticleTitleLong-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy J Gastrointest Surg 1 85–91 Occurrence Handle10.1016/S1091-255X(97)80014-5 Occurrence Handle9834334

    Article  PubMed  Google Scholar 

  40. M Rioux A Asselin R Gregoire C Dallaire (1995) ArticleTitleDelayed peritoneal and retroperitoneal abscesses caused by spilled gallstones: a complication following laparoscopic cholecystectomy Abdom Imaging 20 219–221 Occurrence Handle1:STN:280:ByqA2crnvVY%3D Occurrence Handle7620410

    CAS  PubMed  Google Scholar 

  41. D Rosin Y Korianski A Yudich A Ayalon (1995) ArticleTitleLost gallstones found in a hernial sac J Laparoendosc Surg 5 409–411 Occurrence Handle1:STN:280:BymA2MnlvVE%3D Occurrence Handle8746995

    CAS  PubMed  Google Scholar 

  42. MA Rothlin O Schob R Schlumpf F Largiader (1997) ArticleTitleStones spilled during cholecystectomy: a long-term liability for the patient Surg Laparosc Endosc 7 432–434 Occurrence Handle10.1097/00019509-199710000-00016 Occurrence Handle1:STN:280:DyaK1c%2FgvFagtg%3D%3D Occurrence Handle9348628

    Article  CAS  PubMed  Google Scholar 

  43. L Sarli N Pietra R Costi M Grattarola (1999) ArticleTitleGallbladder perforation during laparoscopic cholecystectomy World J Surg 23 1186–1190 Occurrence Handle10.1007/s002689900644 Occurrence Handle1:STN:280:DyaK1Mvjt1ensQ%3D%3D Occurrence Handle10501883

    Article  CAS  PubMed  Google Scholar 

  44. M Schafer C Suter C Klaiber H Wehrli E Frei L Krahenbuhl (1998) ArticleTitleSpilled gallstones after laparoscopic cholecystectomy A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies. Surg Endosc 12 305–309

    Google Scholar 

  45. E Shocket (1995) ArticleTitleAbdominal abscess from gallstones spilled at laparoscopic cholecystectomy Case report and review of the literature. Surg Endosc 9 344–347 Occurrence Handle1:STN:280:ByqA38%2FnslY%3D

    CAS  Google Scholar 

  46. NJ Soper Dunnegan (1991) ArticleTitleDoes intraoperative gallbladder perforation influence the early outcome of laparoscopic cholecystectomy? Surg Laparosc Endosc 1 156–161 Occurrence Handle1:STN:280:ByuD1c%2FkslI%3D Occurrence Handle1669395

    CAS  PubMed  Google Scholar 

  47. PH Steerman SN Steerman (2000) ArticleTitleUnretrieved gallstones presenting as a streptococcus bovis liver abscess J Soc Laparoendosc Surgeons 4 263–265 Occurrence Handle1:STN:280:DC%2BD3M%2FntlKlsg%3D%3D

    CAS  Google Scholar 

  48. L Steward AL Smith CA Pellegrini (1987) ArticleTitlePigment gallstones form as a composite of bacterial microcolonies and pigment solids Ann Surg 206 242–250 Occurrence Handle3632090

    PubMed  Google Scholar 

  49. SM Strasberg M Hertl NJ Soper (1995) ArticleTitleAn analysis of the problem of biliary injury during laparoscopic cholecystectomy J Am Coll Surg 180 101–125 Occurrence Handle1:STN:280:ByqD1Mznt10%3D Occurrence Handle8000648

    CAS  PubMed  Google Scholar 

  50. G Vadlamudi R Graebe M Khoo R Schinella (1997) ArticleTitleGallstones implanting in the ovary A complication of laparoscopic cholecystectomy. Arch Pathol Lab Med 121 155–158 Occurrence Handle1:STN:280:ByiB2s7gvFc%3D

    CAS  Google Scholar 

  51. CW Warren JI Wyatt (1996) ArticleTitleGallstones split at laparoscopic cholecystectomy: a new cause of intraperitoneal granulomas J Clin Pathol 49 84–85 Occurrence Handle1:STN:280:BymB28vjtlI%3D Occurrence Handle8666694

    CAS  PubMed  Google Scholar 

  52. N Welch RA Hinder RJ Fitzgibbons JW Rouse (1991) ArticleTitleGallstones in the peritoneal cavity: a clinical and experimental study Surg Laparosc Endosc 1 246–247 Occurrence Handle1669413

    PubMed  Google Scholar 

  53. G Wetscher G Schwab F Fend K Glaser D Ladurner E Bodner (1994) ArticleTitleSubcutaneous abscess due to gallstones lost during laparoscopic cholecystectomy Endoscopy 26 324–325 Occurrence Handle1:STN:280:ByuA2Mjht1w%3D Occurrence Handle8076555

    CAS  PubMed  Google Scholar 

  54. J Whiting NT Welch MT Hallissey (1997) ArticleTitleSubphrenic abscess caused by gallstones “lost” at laparoscopic cholecystectomy one year previously: management by minimally invasive techniques Surg Laparosc Endosc 7 77–78 Occurrence Handle10.1097/00019509-199702000-00022 Occurrence Handle1:STN:280:ByiC1cjovVE%3D Occurrence Handle9116958

    Article  CAS  PubMed  Google Scholar 

  55. VL Wills RC Smith (1994) ArticleTitleGallstone ileus: post cholecystectomy Aust N Z J Surg 64 650–652 Occurrence Handle1:STN:280:ByuA28fislM%3D Occurrence Handle8085986

    CAS  PubMed  Google Scholar 

  56. PB Wilton OJ Andy SuffixJr JJ Peters CF Thomas VS Patel CE Scott-Conner (1993) ArticleTitleLaparoscopic cholecystectomy. Leave no (spilled) stone unturned Surg Endosc 7 537–538 Occurrence Handle1:STN:280:ByuD1Mfks1M%3D Occurrence Handle8273004

    CAS  PubMed  Google Scholar 

  57. MA Yerdel I Alacayir U Malkoc F Baba N Erverdi I Pak AG Turkcapar NJ Aras (1997) ArticleTitleThe fate of intraperitoneally retained gallstones with different morphologic and microbiologic characteristics: an experimental study Laparoendosc Adv Surg Tech A 7 87–94 Occurrence Handle1:STN:280:DyaK1c7gsF2itQ%3D%3D

    CAS  Google Scholar 

  58. G Zamir S Lyass D Pertsemlidis B Katz (1999) ArticleTitleThe fate of the dropped gallstones during laparoscopic cholecystectomy Surg Endosc 13 68–70 Occurrence Handle10.1007/s004649900901 Occurrence Handle1:STN:280:DyaK1M%2FovVejtQ%3D%3D Occurrence Handle9869693

    Article  CAS  PubMed  Google Scholar 

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  1. HBP/Upper GI Unit, Department of General Surgery, Auckland City Hospital, Park Road, 92024, Private Bag, Auckland, New Zealand

    J. C. Woodfield, M. Rodgers & J. A. Windsor

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  1. J. C. Woodfield
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  3. J. A. Windsor
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Correspondence to J. A. Windsor.

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Woodfield, J.C., Rodgers, M. & Windsor, J.A. Peritoneal gallstones following laparoscopic cholecystectomy. Surg Endosc 18, 1200–1207 (2004). https://doi.org/10.1007/s00464-003-8260-4

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