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WJOLS
REVIEW ARTICLE Management of Spilled Stones during Laparoscopic Cholecystectomy

Management of Spilled Stones during

Laparoscopic Cholecystectomy

Toma Florin
Department of General Surgery, Bucharest Street, Budila Nr. 8, Romania

Abstract
Laparoscopic cholecystectomy has become the preferred method to treatment for patients with cholelithiasis. Perforation of the
gallbladder during laparoscopic cholecystectomy with spillage of stones into abdominal cavity is not uncommon. Although, overall
complication rate is less than in open technique, injury of biliary tree and perforation of gallbladder with spillage of stones are more frequent
in laparoscopic cholecystectomy.
The fate of spilled bile with gallstone is on a continuous debate. Recent reports have implicated dropped gallstones as a source of
infrequent but severe complications of laparoscopic cholecystectomy. For this reason we have done this review regarding different
possible outcomes, few suggestions to prevent these and their management.
Keywords: Spilled gallstones, lost gallstones, laparoscopic cholecystectomy, spilt gallstone, gallstone retrieval.

INTRODUCTION Even though lost gallstones were initially considered to
be inoffensive, in the past years, with the shift from open
Nowadays, laparoscopic cholecystectomy is considered to cholecystectomy to LC, numerous reviews have reported a
be the golden standard for the treatment of symptomatic wide variety of complications.
gallstone disease. Compared to open surgery, all studies This review aims to categorize these complications
show a lower rate of complications. Compared to open through a systematic literature search in order to show the
cholecystectomy, in LC, there are, however, two more variety of complications and to evaluate the frequency and
frequent problems: (1) Injury to the common bile duct and management of spilled gallstones in LC.
(2) Complications from spilled gallstones. The rate of
common bile duct injuries in LC has declined over the last MATERIALS AND METHODS
15 years, due to the fact that laparoscopic surgeons have
gained more experience; but, unfortunately, the incidence The search was performed using the following search
engines: Google, Springer link and Medline. The search
of spilled gallstones has remained unchanged. strategy was performed with the below mentioned key
During the open cholecystectomy, spillage from the
gallbladder cannot migrate from the right upper quadrant, words and combinations: “spilled gallstones”, “lost
gallstones”, “laparoscopic cholecystectomy”, “spilt
as it is packed off routinely and Morrison’s pouch occluded gallstone” and “gallstone retrieval”.
with a laparotomy pad. In LC, stones can become Out of 412 listed references, titles, abstracts, and full
disseminated in abdominal cavity. text articles were monitored to accumulate a selection of
The common bile duct injury and bile leakage can be relevant studies. Afterwards, all reviews and case reports
diagnosed soon after operation, but intraperitoneal gallstone concerning lost gallstones in LC were screened for the
spillage can manifest only months to years after the reported complications.
operation, and may have a confusing preservation, that leads The main search criterion was the “management of spilled
to further examinations. gallstones”, thus all studies that reported the incidence of
During laparoscopy, bile spillage is still relatively benign; lost peritoneal gallstones and/or perforated gallbladder were
however, the loss of gallstones causes considerable analyzed in this review for the intraoperative and
morbidity. postoperative actions.

World Journal of Laparoscopic Surgery, May-August 2010;3(2):103-107 103