Consequences of Lost Gallstones During Laparoscopic Cholecystectomy: A Review Article.
BACKGROUND
Laparoscopic cholecystectomy (LC) has become a popular and widespread procedure for the treatment of gallstone disease. There is still an increasing concern about specific complications of LC due to gallbladder perforation and spillage of bile and stones. Although unretrieved intraperitoneal gallstones rarely become symptomatic, their infective complications may cause serious morbidities even after a long interval from LC.


METHODS
We performed a review of the literature on the diagnosis, prevention, consequences, and management of lost gallstones. All studies with a focus on lost gallstones or perforated gallbladder were analyzed to evaluate the postoperative complications.


RESULTS
Between 1991 and 2015, >250 cases of postoperative complications of spilled gallstones were reviewed in the surgical literature. The most common complications are intraperitoneal abscesses and fistulas. Confusing clinical pictures due to gallstones spreading in different locations makes diagnosis challenging. Even asymptomatic dropped gallstones may masquerade intraperitoneal neoplastic lesions.


CONCLUSIONS
Every effort should be made to prevent gallbladder perforation; otherwise, they should be retrieved immediately during laparoscopy. In cases with multiple large spilled stones or infected bile, conversion to open surgery can be considered. Documentation in operative notes and awareness of patients about lost gallstones are mandatory to early recognition and treatment of any complications.
Surgical Oncology Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Azadeh
A
Jabbari Nooghabi
Masoumeh
M
Hassanpour
Ali
A
Jangjoo
D000818:Animals; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D002764:Cholecystitis / Q000601:surgery; D004195:Disease Models, Animal; D005704:Gallbladder / Q000293:injuries; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D051379:Mice; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography