The need to retrieve the dropped stone during laparoscopic cholecystectomy.
The effect of bile and gallstones on the peritoneal cavity was evaluated in an experimental animal study. Ninety male Sprague-Dawley rats were randomly allocated to one of six groups (n = 15). Groups 1 to 3 received an intraperitoneal injection (2 mL) of saline, sterile bile, and infected bile, respectively. Groups 4 to 6 underwent a lower midline abdominal incision (3 to 5 mm). In groups 4 and 5, a single gallstone (< 3 mm diameter) was placed in the right upper quadrant and, after closure of the wound, the animals were injected with sterile bile and infected bile, respectively. Group 6 animals underwent laparotomy alone, followed by injection of sterile saline (2 mm). All animals were killed at 4 weeks and the peritoneal cavity was carefully examined. No intra-abdominal lesions were noted in groups 1 to 3. Adhesions were noted in 11 (73%) and 10 (67%) animals of groups 4 and 5, respectively. Two intra-abdominal abscesses were noted in group 4 animals. No intra-abdominal lesions were noted in any group 6 animals. This study suggests that bile in combination with gallstones in the peritoneal cavity is associated with an increased risk of intra-abdominal adhesion formation and possible abscess formation, and that every attempt should be made to retrieve stones lost during cholecystectomy.
Johnston
S
S
Beaumont Hospital, Dublin, Ireland.
O'Malley
K
K
McEntee
G
G
Grace
P
P
Smyth
E
E
Bouchier-Hayes
D
D
D000818:Animals; D001646:Bile / Q000502:physiology*; D017081:Cholecystectomy, Laparoscopic / Q000592:standards*; D002769:Cholelithiasis / Q000150:complications* / Q000503:physiopathology; D008297:Male; D010532:Peritoneal Diseases / Q000209:etiology* / Q000503:physiopathology; D011897:Random Allocation; D051381:Rats; D017207:Rats, Sprague-Dawley; D000267:Tissue Adhesions / Q000209:etiology / Q000503:physiopathology