title: Long-term consequences of intraoperative spillage of bile and gallstones during laparoscopic cholecystectomy.
abstract: Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis (P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra- abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra- abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact ( P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.
authors.affiliation: Department of Surgery, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: Rice
authors.forename: M A
authors.initials: MA
authors.lastname: Memon
authors.forename: R L
authors.initials: RL
authors.lastname: Jamison
authors.forename: T
authors.initials: T
authors.lastname: Agnessi
authors.forename: D
authors.initials: D
authors.lastname: Ilstrup
authors.forename: M B
authors.initials: MB
authors.lastname: Bannon
authors.forename: M B
authors.initials: MB
authors.lastname: Farnell
authors.forename: C S
authors.initials: CS
authors.lastname: Grant
authors.forename: M G
authors.initials: MG
authors.lastname: Sarr
authors.forename: G B
authors.initials: GB
authors.lastname: Thompson
authors.lastname: van Heerden JA
authors.forename: S P
authors.initials: SP
authors.lastname: Zietlow
authors.forename: J H
authors.initials: JH
authors.lastname: Donohue
mesh_terms: D001646:Bile; D002769:Cholelithiasis / Q000601:surgery*; D005260:Female; D005704:Gallbladder / Q000293:injuries*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies