Retroperitoneoscopy to Extract Dropped Gallstones After Laparoscopic Cholecystectomy

Percutaneous Endoscopy and Image-guided Retrieval of Dropped Gallstones - A Case Series

BACKGROUND

Recurrent abscesses can happen due to dropped gallstones (DGs) after laparoscopic cholecystectomy (LC). Recognition and appropriate percutaneous endoscopy and image-guided treatment options can decrease morbidity associated with this condition.

MATERIALS AND METHODS

We report a minimally invasive endoscopy and image-guided technique for retrieval of dropped gallstones in a series of 6 patients (M/F=3/3; median age: 75.5 years [68 to 82]) presenting with recurrent or chronic intra-abdominal abscesses secondary to dropped gallstones. Technical success was defined as the visualization and retrieval of all stones. DGs were identified on pre-procedure imaging. Number of abscesses recurrence was 12 (1/6), 1 (3/6), and 0 (2/6) with a median interval of 2 months (1 to 21) between cholecystectomy and abscess development.

RESULTS

Percutaneous endoscopy and fluoroscopy guidance were utilized in all cases. Technical success was achieved in 4 patients (66%). The median procedure time was 65.8 minutes (39 to 136). The median fluoroscopy time and dose were 12.6 min (3.3 to 67) and 234 mGy (31 to 1457), respectively. There were no intraprocedure and postprocedure complications. No abscess recurrence was reported among successful procedures during a median follow-up of 193 days (51 to 308).

CONCLUSION

Percutaneous image and endoscopy-guided lithotripsy/lithectomy are safe and effective. This technique is a suitable alternative to open surgery for dropped gallstones.

LEVEL OF EVIDENCE

Level 4, Case Series.

Dropped Gallstone-Related Right Subhepatic and Parietal Wall Abscess: A Rare Complication After Laparoscopic Cholecystectomy

Gallbladder perforation and stone spillage is a common intraoperative problem during laparoscopic cholecystectomy. Most of these stones are retrieved intraoperatively. The incidence of lost or unretrieved stones is approximately 2%, and very few patients may develop complication. Most common complication of dropped or spilled gallstones is abscess, particularly around the abdominal wall port sites and in the perihepatic space. We report a case of dropped stone-related right subhepatic and parietal wall abscess 39 months after laparoscopic cholecystectomy. The patient was treated successfully by operative drainage of the abscess along with complete removal of stones. The patient was asymptomatic at 6-month follow-up.

Ultrasound-guided percutaneous retrieval of a dropped gallstone following laparoscopic cholecystectomy

Removal of intraabdominal dropped gallstones remains a challenging problem for both surgeon and radiologist. We describe in this report a novel, minimally invasive technique to successfully remove a dropped gallstone, causing recurrent intra-abdominal infection, from a patient who had undergone laparoscopic cholecystectomy.