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Danhel L, Fritz A, Havranek L, Kratzer T, Punkenhofer P, Punzengruber A, Rezaie D, Tatalovic S, Wurm M, Függer R, Biebl M, Kirchweger P. Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication-case report and review of the literature. Front Surg 2024; 11:1375502. [PMID: 38655209 PMCID: PMC11035747 DOI: 10.3389/fsurg.2024.1375502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/18/2024] [Indexed: 04/26/2024] Open
Abstract
Introduction Laparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC. Methods Case report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022. Case Report An 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation. Conclusion Intraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
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Affiliation(s)
- L. Danhel
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Fritz
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - L. Havranek
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - T. Kratzer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - P. Punkenhofer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - A. Punzengruber
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - D. Rezaie
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - S. Tatalovic
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
| | - M. Wurm
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
| | - R. Függer
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - M. Biebl
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
| | - P. Kirchweger
- Department of Surgery, Ordensklinikum Linz, Linz, Austria
- VYRAL, Linz, Austria
- Medical Faculty, Johannes Kepler University, Linz, Austria
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Gavriilidis P, Catena F, de’Angelis G, de’Angelis N. Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review. World J Emerg Surg 2022; 17:57. [PMID: 36324150 PMCID: PMC9632095 DOI: 10.1186/s13017-022-00456-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/22/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years. METHODS Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature. RESULTS Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported. CONCLUSIONS Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.
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Affiliation(s)
- Paschalis Gavriilidis
- grid.412944.e0000 0004 0474 4488Department of Surgery, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ Cornwall UK
| | - Fausto Catena
- grid.414682.d0000 0004 1758 8744Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy
| | - Gianluigi de’Angelis
- grid.10383.390000 0004 1758 0937Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy
| | - Nicola de’Angelis
- grid.508487.60000 0004 7885 7602Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, Clichy, France
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Salati SA, Alfehaid M, Alsuwaydani S, AlSulaim L. Spilled gallstones after laparoscopic cholecystectomy: a systematic review. POLISH JOURNAL OF SURGERY 2022; 95:1-20. [PMID: 36805307 DOI: 10.5604/01.3001.0015.8571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b> Aim: </b> The study was conducted to analyse the recent peer-reviewed literature related to symptomatic spilled gallstones after Laparoscopic Cholecystectomy (LC). </br></br> <b>Materials and methods:</b> Articles published in the peer-reviewed journals of repute from 20122022 were evaluated for nine variables including: [I] age of the patient, [II] gender, [III] interval since index LC, [IV] index LC if emergent/difficult or elective/straightforward, [V] clinical presentation, [VI] spilled gallstones if detected by imaging, [VII] management, [VIII] approach to management, [IX] number of spilled gallstones. </br></br> <b>Results:</b> There were a total of 71 cases (37 males and 34 females) with a mean age of 63.7 years. The time of onset of symptoms from spilled gallstones, after index LC, ranged from 2 days to 15 years and 57 patients (80.3%) presented within 6 years. Forty (56.3%) patients were unaware of the fact that gallstone spillage had occurred during index LC. The retained gallstones were detected by imaging in 47 (66.1%) cases and they were multiple in 51 (71.8%). In 52 patients (73.2%), the stones manifested as abdominal abscess/foreign body granuloma; the other presentations being pelvic pain/fistula, intestinal obstruction, abdominal lump simulating malignancy, incidental finding of metastatic lesions and generalized peritonitis. The major approaches adopted to retrieve the retained stones included open surgery, laparoscopy and percutaneous drainage. There were two deaths (2.9%) due to spilled gallstones. </br></br> <b>Conclusion:</b> Retained gallstones represent a complication of laparoscopic cholecystectomy (LC) that has a potential to create morbidity and diagnostic difficulties, even after a substantial delay. There is a need to spread awareness about the adverse effects of spilled stones so that they are actively looked for and retrieved if gallbladder perforates during cholecystectomy. Whenever such a complication occurs, the patient should be properly informed and the details should be very clearly mentioned in the operation notes.
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Affiliation(s)
- Sajad Ahmad Salati
- Unaizah College of Medicine and Medical Sciences, Qassim University, Saudi Arabia
| | - Mohammed Alfehaid
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
| | - Saleh Alsuwaydani
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
| | - Lamees AlSulaim
- Department of Surgery Unaizah College of Medicine and Medical Sciences, Qassim University, Kingdom of Saudi Arabia
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Tokuda A, Maehira H, Iida H, Mori H, Nitta N, Maekawa T, Takebayashi K, Kaida S, Miyake T, Kuroda R, Yamamoto H, Tani M. Pleural empyema caused by dropped gallstones after laparoscopic cholecystectomy for acute cholecystitis: a case report. Surg Case Rep 2022; 8:62. [PMID: 35389108 PMCID: PMC8991281 DOI: 10.1186/s40792-022-01419-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/03/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Dropped gallstones during laparoscopic cholecystectomy (LC) sometimes induce postoperative infectious complications. However, pleural empyema rarely occurs as a complication of LC. CASE PRESENTATION We present the case of a 66-year-old woman with right pleural empyema. She previously underwent LC for acute gangrenous cholecystitis 11 months ago. The operative report revealed iatrogenic gallbladder perforation and stone spillage. The bacterial culture of the gallbladder bile was positive for Escherichia coli. Chest and abdominal computed tomography revealed right pleural effusion, perihepatic fluid collection, and multiple small radiopaque density masses. Although ultrasound-guided transthoracic drainage was performed, the drainage was incomplete, and systemic inflammatory reaction persisted. Consequently, thoracotomy and laparotomy with gallstone retrieval were performed, and the patient recovered completely. The patient has remained well without complications after 14 months of follow-up. CONCLUSIONS We report a rare case of pleural empyema caused by dropped gallstones after LC. This case emphasized the importance of completely retrieving the dropped gallstones to prevent late infectious complications after LC.
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Affiliation(s)
- Aya Tokuda
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan.
| | - Hiroya Iida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Haruki Mori
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Nobuhito Nitta
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Takeru Maekawa
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Katsushi Takebayashi
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Sachiko Kaida
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
| | - Ryo Kuroda
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Haruka Yamamoto
- Division of Respiratory Medicine, Department of Internal Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Seta-tsukinowacho, Otsu, Shiga, 520-2192, Japan
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