A team from Munster, Germany, identified predisposing factors for complications after gallstone spillage during laparoscopic cholecystectomy (LC).
Using a Medline search, the research group identified relevant papers, and analyzed a total of 91 reports on complications caused by lost gallstones published between 1991 and 1998.
The patients in these reports were then compared with cases in published series on LC in general.
Gallbladder perforation (20%) and stone spillage (9%) were the 2 most common complications of LC, occurring during the dissection (75%) and removal (25%) of the gallbladder.
Predisposing factors for developing complications after stone spillage included older age, male sex, acute cholecystitis, and spillage of pigment stones.
| More than 15 gallstones - a predisposing factor for complications in LC.|
| Surgical Endoscopy |
The number of stones (> 15) or size of the stone (diameter > 1.5 cm), and perihepatic localization of lost stones, were also predictors of complications.
It was found that CT scan and ultrasound examination proved best for the recognition of complications caused by lost stones.
Explorative laparotomy and surgical removal of the stones was the most frequently used therapy.
Dr J. G. Brockmann said on behalf of fellow authors, "Gallbladder perforation and stone spillage might cause hazardous complications."
Dr Brockmann concluded, "In cases with loss of numerous or large pigment stones which cannot be retrieved by laparoscopy, intraoperative conversion to open surgery can be justified."