Complications of Spilt Gallstones During Laparoscopic Cholecystectomy

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Complications of Spilt Gallstones During Laparoscopic Cholecystectomy

Journal Title: International Journal of Medical Research Professionals - Year 2017, Vol 3, Issue 3

Abstract

Background: Laparoscopic cholecystectomy is the gold standard for symptomatic gallstones because of cosmesis, less hospital stay, less post-operative pain and less disability in comparison to open cholecystectomy. Gallbladder perforation with stones spillage into the peritoneal cavity is more frequent in laparoscopic cholecystectomy which is about 6% to 40%. Only 13% to 32% of stones will be retained in the peritoneal cavity, rest of the stones can be retrieved by direct visualization and saline irrigation. Retained stones can be the cause of post-operative morbidity accounting for 0.1% to 6%. Most of the time it is asymptomatic and few can present with fever, chronic abdominal pain, intestinal obstruction. The aim of this study to documented the incidence of gallstone spillage during laparoscopic cholecystectomy. Material & Methods: The study included 50 randomized cases of laproscopic cholecystectomy performed in the Department of General Surgery, S.P. Medical College and P.B.M. Associated Group of Hospitals, Bikaner between 1st June 2014 to 31st May 2015. A prospective collection of data were obtained in accordance with the proforma which documented patients details, diagnosis, preoperative physical and ultrasound abdomen findings, intraoperative details such as technique, spillage of stones, cause for spillage, method and port of extraction of specimen, postoperative events, and complications. The follow-up was performed at the end of 1 week, 1 month, 6 months of postoperative. Data collected were analyzed for incidence of spillage of gallstones and complications related to such events during laparoscopic cholecystectomy. Results: In this study the maximum numbers of cases were in the 15-30 years of age group. The 54.55% of cases of spillage occurred during dissection. In this study out of these 12 cases, 8 cases had gall stone spillage and 4 cases didn’t have any spillage, which are statistically significant (p=0.001). The present study showed out of 50 cases, 11 cases had either increased or decreased volume of gall bladder in preoperative sonography. Among these 11 cases, 7 cases had gallstone spillage and 4 cases had normal laparoscopic cholecystectomy, which are statistically significant (p=0.0065). Conclusion: We concluded that, the operative surgeons should be well trained in laparoscopic surgeries and surgeons should consider meticulous and care dissection while operative. Every effort should be made to remove gallstone spilled out by various approach. Operating surgeons should keep a clean follow up of these patients and common and rare complications should be kept in mind while treating these patients in immediate postoperative period and long term follow up.

Authors and Affiliations

Umrao Singh, Gajendra Saxena, Mohd. Salim, Vijay HS, Sunil Kumar Dangi

Keywords

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EP ID EP547771
DOI 10.21276/ijmrp.2017.3.3.005
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