title: Is the loss of gallstones during laparoscopic cholecystectomy an underestimated complication?
abstract: Laparoscopic cholecystectomy entails an increased risk of gallbladder rupture and consequent loss of stones in the abdominal cavity. Herein we report the case of a 51-year-old male patient, who underwent laparoscopic cholecystectomy 2 years before presentation to our hospital. He had experienced tension sensation and epigastric pain since 4 months postoperatively. A well-defined epigastric mass, which was hard and painful on palpation, was detected and later confirmed by ultrasonography and CT scan. Explorative laparotomy revealed a mass in the area of the gastrocolic ligament,resulting from biliary gallstones in conjunction with a perimetral inflammatory reaction. A review of the literature showed that the incidence of gallbladder lesions during laparoscopy is 13-40%. In order to prevent this complication, meticulous isolation of the gallbladder, proper dissection of the cystic duct and artery, and careful extraction through the umbilical access are required. Ligation after the rupture or use of an endo-bag may be helpful. The loss of gallstones and their retention in the abdominal cavity should be noted in the description of the surgical procedure.
authors.affiliation: Divisione di Chirurgia Generale II, Università degli Studi di Milano, Ospedale Luigi Sacco, Cattedra di Chirurgia Generale, Via G. B. Grassi 74, 20157 Milan, Italy. massimo.tos@unimi.it
authors.forename: S
authors.initials: S
authors.lastname: Gerlinzani
authors.forename: M
authors.initials: M
authors.lastname: Tos
authors.forename: R
authors.initials: R
authors.lastname: Gornati
authors.forename: B
authors.initials: B
authors.lastname: Molteni
authors.forename: D
authors.initials: D
authors.lastname: Poliziani
authors.forename: A M
authors.initials: AM
authors.lastname: Taschieri
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002765:Cholecystography; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D005704:Gallbladder / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000473:pathology; D007813:Laparotomy; D008022:Ligaments / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010532:Peritoneal Diseases / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D012421:Rupture; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography