Jasim D Saud#, Mazin A Abdulla@ & Mushtaq Ch. Abu-Alhail*
*#MBChB, CABS, Specialist Surgeon, Basrah General Hospital, Basrah, Iraq. @MBChB, CABS,
Consultant Surgeon, Department of Surgery, College of Medicine, University of Basrah, Basrah, Iraq.
This study assesses the impact of spilled gall stones during laparoscopic cholecystectomy (LC)
and it's clinically significant complications resulting from stones left in the peritoneum.
This is a prospective analysis of laparoscopic cholecystectomies performed at The Surgical
Unit in Basrah General Hospital from 1st January 2006 to 31st December 2010. There were 678
patients in the study who underwent LC. The inclusion criteria for LC were: patients of all ages
and both genders, symptomatic gallstone disease, recurrent attack while waiting for interval LC,
normal values of blood complete picture & liver function tests and ultrasound examination of
abdomen demonstrating gallstone disease.
There were 73 cases of gallbladder perforation, i.e. a frequency of 10.7%. In 34 of these
patients gallstones spillage also occurred in a frequency of 5%. An effort was made in each
case to remove the spilled stones laparoscopically but in 25 patients unretrieved stones were
left (frequency of 3.6%). Eight patients (1.17%) developed complications, one patient developed
ileus which was thought to be the result of irritation from a gallstone that had been shown on US
examination. The free fluid in the Douglas pouch resolved with medical management. Two
patients developed sub-hepatic abscess, presenting with right hypochondrial & shoulder tip pain
and fever post operatively; which confirmed by abdominal sonograph, one patient responded
well to medical treatment while the other one required ultrasound guided drainage and broadspectrum
antibiotics. Three patients developed epigastric port site infection; two were treated
successfully by daily wound care and appropriate antibiotics after culture and sensitivity. One
developed persistent epigastric sinus, and a gallstone was retrieved on exploration. Two
patients developed sub-hepatic and right sub-phrenic abscess respectively in the seventh post
operative day and required open drainage. There was no mortality and long-term morbidity.
In conclusion, complications arising from spillage of gall stones during laparoscopic
cholecystectomy are rare. They can present months after the cholecystectomy with septic
complications. The patients should be informed preoperatively that spillage of bile and
gallstones are possible. The surgeon should take utmost care to prevent spillage of stones and
attempt to remove all visible stones at the time of surgery. If spillage occurred it should be
recorded clearly in the operative notes and such patients should be kept under close follow up
to aid in the early diagnosis of later complications. There is no indication for routine conversion
to open surgery.