Evaluation of the incidence of complications of lost gallstones during laparoscopic cholecystectomy.
OBJECTIVE
Recently, an increasing number of reports in the literature have shown various complications of lost gallstones. This study aimed to evaluate patients with lost stones in the peritoneal cavity for any related complications for at least 12 months after the operation.


METHODS
In a 3-year prospective study, of 900 patients with laparoscopic cholecystectomy, 50 patients with lost stones in the peritoneal cavity were enrolled as the case group. On the same day or the day after, an uncomplicated case was assigned to the control group. Postoperative complications were checked on the 10th day and 1, 6, and 12 months after surgery. They were also visited if they had any complaints at any time. All suspicious cases and also all patients in the last follow-up visit underwent abdominal ultrasonography and were observed for signs of abdominal and port site collections, abdominal and port site stone, abscess, and mass.


RESULTS
In 50 cases (34 female and 16 male with a mean age of 59 y), the surgeon was doubtful about proper stone extraction. The mean duration of operation for patients with a ruptured gall bladder was 49.6+30.3 minutes, and in others, it was 27.9+11.7 minutes. During the early postoperative period, fever was detected in 3 (6%) patients in the case group and in 1 (2%) patient in the control group, which was resolved spontaneously. Postoperative pain on the 10th and the 30th days, unrelated to the lost stone, was resolved with analgesics. Abdominal collection was found in 8 (16%) patients in the case group and 5 (10%) patients in the control group, which was not significant. All these patients underwent ultrasonography-guided percutaneous aspiration. The aspirate was serous, and the patients' clinical findings were not clinically significant.


CONCLUSIONS
According to the study, serious complications related to the lost stones indicate prophylaxis as the best therapeutic approach for such patients. The patients should be informed about lost stones and their possible complications. Also, conversion to open surgery is not advised.
Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
Abdolreza
A
Pazouki
Abbas
A
Abdollahi
Mostafa
M
Mehrabi Bahar
Ali
A
Jangjoo
Masoud
M
Pezeshki Rad
Mohsen
M
Aliakbarian
Mehdi
M
Jabbari Nooghabi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D042882:Gallstones / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D014463:Ultrasonography