Role of a hyaluronic-acid derivative in preventing surgical adhesions and abscesses related to dropped bile and gallstones in an experimental model

The Effect of Ellagic Acid on Intra-abdominal Adhesions Caused by Gallstones

BACKGROUND

Adhesion formation after peritoneal surgery is the main cause of postoperative bowel obstruction, infertility, and chronic pelvic pain. In this study, we evaluated the effect of oral ellagic acid on intra-abdominal adhesions caused by gallstones in rats.

MATERIALS AND METHODS

Forty-one Wistar-albino rats were used. Gallstones were dropped to the right lower quadrant of the abdomen to create adhesions. They were divided into 4 groups; sham-operated, intraperitoneal gallstone, oral ellagic acid (control), and intraperitoneal gallstone+oral ellagic acid. On the postoperative 10th day, relaparotomy was performed, adhesions were evaluated according to four different macroscopic adhesion score systems and adhesion-bearing tissues were examined histopathologically. Samples were graded for inflammation, vascularization, and fibrosis.

RESULTS

We found that oral administration of ellagic acid lowered all macroscopic adhesion scores. There were significant differences between groups of sham and gallstone; control and gallstone; control and gallstone+oral ellagic acid (P<0.05).

CONCLUSION

The ellagic acid administered orally at a dose of 100 mg/kg/d significantly inhibited intra-abdominal adhesion formation and no adverse effects were seen between treatments.

Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article

BACKGROUND

Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC.

METHODS

We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications.

RESULTS

Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions.

CONCLUSIONS

Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.

Abdominal wall abscess after cholecystectomy

Background

Laparoscopic cholecystectomy is one of the most frequently performed surgical interventions nowadays in developed countries. While lost gallstones during the procedure represent a commonly encountered issue, there is an ongoing debate whether split gallstones imperatively need to be extracted during the same procedure. The reported case of a wall abscess several years after follow-up lights up this debate.

Case presentation

A 75-year-old male Caucasian with a history of rheumatoid arthritis and congestive heart failure presented with a recurrent subcutaneous abdominal wall abscess with occasional, spontaneous drainage of pus. He underwent laparoscopic cholecystectomy for acute calculous cholecystitis 3 years ago with uneventful and prompt recovery. A computed tomography scan showed a cavity in the periumbilical abdominal wall with peripheral contrast-enhancing, next to a calcified foreign body between the rectus muscle sheets. Wound exploration under general anaesthesia was performed with drainage of the cavity, extraction of the foreign body and closure of the anterior rectus sheet over a drainage catheter. The foreign body turned out to be a gallstone lost in the periumbilical port site during the procedure. Antibiotic treatment with co-amoxiclav was continued for 14 days. The patient was discharged 9 days postoperatively with a clean wound.

Conclusion

This case and short review of the literature is a reminder of the importance of careful extraction of split gallstones during cholecystectomy in order to avoid early or late complications. This is especially important in the light of one of the most commonly performed surgical procedures in developed countries with generally low morbidity.

The effect of different temporary abdominal closure techniques on fascial wound healing and postoperative adhesions in experimental secondary peritonitis

BACKGROUND

Secondary peritonitis causes considerable mortality and morbidity. New strategies have been introduced like relaparotomy and temporary abdominal closure in the management of such persistent intra-abdominal infections.

MATERIALS AND METHODS

Rats were divided into five groups each having ten animals. After induction of peritonitis, relaparotomies were done, and the abdomen was closed by different temporary abdominal closure techniques. After performing two relaparotomies during a 48-h period, all fascias closed primarily and incisional tensile strengths, hydroxyproline contents, and adhesions were measured on the following seventh day.

RESULTS

The median values of tensile strength and hydroxyproline concentrations were lowest in skin-only closure rats. Intraperitoneal adhesion scores were highest in Bogota bag closure group.

CONCLUSION

Primary, Bogota bag, and polyprolene mesh closures seem to be safe in terms of early fascial wound healing. Although it is easy to perform, skin-only closure technique has deleterious effects on fascial wound healing probably due to fascial retraction. Interestingly, Bogota bag has caused increased intraperitoneal adhesion formation.

Lost gallstones in laparoscopic cholecystectomy: all possible complications

BACKGROUND

Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones.

DATA SOURCES

A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones.

CONCLUSION

Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.