Muhammad Shamim, Amjad Siraj Memon, Mir Muhammad Dahri, Khurshid Samo2 Mbbs.
Gallbladder perforation and stone spillage during laparoscopic Cholecystectomy.
Med Channel Jan ;12(2):40-3.

OBJECTIVE: To determine the frequency of gallbladder perforation & stone spillage during laparoscopic cholecystectomy (LC), and its subsequent complication & management. DESIGN: Descriptive case-series. PLACE & DURATION OF STUDY: This is a prospective analysis of laparoscopic cholecystectomies performed at Surgical Unit I, Civil Hospital Karachi, from 1st September 1997 to I5th June 2005. PATIENTS & METHODS: There were 1246 patients in the study, who underwent LC. The inclusion criteria for LC were: patients of all ages & both sexes, symptomatic gallstone disease, recurrent attack while waiting for interval LC, normal levels of blood complete picture & liver function tests, & ultrasound abdomen demonstrating gallstone disease. RESULTS: There were 107 cases of gallbladder perforation, ie a frequency of 8.59%. In 24 of these patients gallstones spillage also occurred, ie a frequency of 1.92%. An effort was made in each case to remove the spilled stones laparoscopically, but in seven patients unretrieved stones were left (ie a frequency of 0.56%). One patient developed pelvic abscess, presenting with post-operative diarrhea & fever on day 5 & confirmed by ultrasound; it was left to drain in the rectum & treated by broad-spectrum antibiotics. Four patients developed sub-hepatic abscess, presenting with right hypochondria! & shoulder tip pain & fever on day 3; they were confirmed by ultrasound, with subsequent ultrasound guided drainage & broad-spectrum antibiotics. Three patients developed epigastric port site infection; two were treated successfully by daily wound care & appropriate antibiotics after culture & sensitivity. One developed persistent epigastric sinus, & a gallstone was retrieved on exploration. There was no mortality & long-tertn morbidity. CONCLUSION: Gallbladder perforation & stone spillage are frequent occurrence during laparoscopic cholecystectomy. Active laparoscopic retrieval of spilled stones & thorough irrigation of sub-hepatic area reduces the risk of subsequent complications.

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