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Fate of lost gallstones during laparoscopic cholecystectomy
BACKGROUNDS/AIMS: The fate of gallstones that remain in the peritoneal cavity due to perforation of the gallbladder during laparoscopic cholecystectomy (LC) has been studied vigilantly since the early 1990s when this surgical procedure started to be used. But the complication statistics vary with ea...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Korean Association of Hepato-Biliary-Pancreatic Surgery
2013
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304497/ https://www.ncbi.nlm.nih.gov/pubmed/26155216 http://dx.doi.org/10.14701/kjhbps.2013.17.2.66 |
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author | Lee, Whanbong Kwon, Jungnam |
author_facet | Lee, Whanbong Kwon, Jungnam |
author_sort | Lee, Whanbong |
collection | PubMed |
description | BACKGROUNDS/AIMS: The fate of gallstones that remain in the peritoneal cavity due to perforation of the gallbladder during laparoscopic cholecystectomy (LC) has been studied vigilantly since the early 1990s when this surgical procedure started to be used. But the complication statistics vary with each report. So we reviewed our 47 cases of lost stones that were traceable from 1998 to 2007. METHODS: Stones entered the peritoneal cavity through the perforation site during dissection of the body or Hartmann's pouch of gallbladder from the liver bed, despite trials of stone removal like irrigation and using a glove finger pouch especially in the case of numerous small stones. There were nine cases of lost stones that were caused by fragments of stone breaking from a large stone during its retrieval. RESULTS: No patient was forced into revision surgery or intervention for the missing stones but only negative suction drains were inserted, and information to the patients was given. Most of the stones (N=42, 89.4%) remained silent during the follow-up period of 10.4±3.6 years, and 5 patients (10.6%) developed inflammatory complications in the peritoneal cavity and abdominal wall. Two intraperitoneal abscesses were found in the right subhepatic area and a cul-de-sac and these were managed by laparotomy. Subhepatic abscess was later associated with intestinal obstruction. Two patients suffered an umbilical portal site fistula and a right flank portal fistula respectively, requiring prolonged wound care. One patient suffered immediate postoperative peritonitis that was cured by antibiotics. CONCLUSIONS: Lost stones should be retrieved or fragmented as much as possible for removal through a drain, and caution should be exercised during dissection of the gallbladder to avoid perforating the gallbladder. Considering the approximately 10% incidence of serious inflammatory complications of lost stones, the complications should be explained to patients to allow for earlier diagnosis of complications later. |
format | Online Article Text |
id | pubmed-4304497 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2013 |
publisher | Korean Association of Hepato-Biliary-Pancreatic Surgery |
record_format | MEDLINE/PubMed |
spelling | pubmed-43044972015-07-07 Fate of lost gallstones during laparoscopic cholecystectomy Lee, Whanbong Kwon, Jungnam Korean J Hepatobiliary Pancreat Surg Original Article BACKGROUNDS/AIMS: The fate of gallstones that remain in the peritoneal cavity due to perforation of the gallbladder during laparoscopic cholecystectomy (LC) has been studied vigilantly since the early 1990s when this surgical procedure started to be used. But the complication statistics vary with each report. So we reviewed our 47 cases of lost stones that were traceable from 1998 to 2007. METHODS: Stones entered the peritoneal cavity through the perforation site during dissection of the body or Hartmann's pouch of gallbladder from the liver bed, despite trials of stone removal like irrigation and using a glove finger pouch especially in the case of numerous small stones. There were nine cases of lost stones that were caused by fragments of stone breaking from a large stone during its retrieval. RESULTS: No patient was forced into revision surgery or intervention for the missing stones but only negative suction drains were inserted, and information to the patients was given. Most of the stones (N=42, 89.4%) remained silent during the follow-up period of 10.4±3.6 years, and 5 patients (10.6%) developed inflammatory complications in the peritoneal cavity and abdominal wall. Two intraperitoneal abscesses were found in the right subhepatic area and a cul-de-sac and these were managed by laparotomy. Subhepatic abscess was later associated with intestinal obstruction. Two patients suffered an umbilical portal site fistula and a right flank portal fistula respectively, requiring prolonged wound care. One patient suffered immediate postoperative peritonitis that was cured by antibiotics. CONCLUSIONS: Lost stones should be retrieved or fragmented as much as possible for removal through a drain, and caution should be exercised during dissection of the gallbladder to avoid perforating the gallbladder. Considering the approximately 10% incidence of serious inflammatory complications of lost stones, the complications should be explained to patients to allow for earlier diagnosis of complications later. Korean Association of Hepato-Biliary-Pancreatic Surgery 2013-05 2013-05-31 /pmc/articles/PMC4304497/ /pubmed/26155216 http://dx.doi.org/10.14701/kjhbps.2013.17.2.66 Text en Copyright © 2013 by The Korean Association of Hepato-Biliary-Pancreatic Surgery http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article Lee, Whanbong Kwon, Jungnam Fate of lost gallstones during laparoscopic cholecystectomy |
title | Fate of lost gallstones during laparoscopic cholecystectomy |
title_full | Fate of lost gallstones during laparoscopic cholecystectomy |
title_fullStr | Fate of lost gallstones during laparoscopic cholecystectomy |
title_full_unstemmed | Fate of lost gallstones during laparoscopic cholecystectomy |
title_short | Fate of lost gallstones during laparoscopic cholecystectomy |
title_sort | fate of lost gallstones during laparoscopic cholecystectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304497/ https://www.ncbi.nlm.nih.gov/pubmed/26155216 http://dx.doi.org/10.14701/kjhbps.2013.17.2.66 |
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