Review
Lost gallstones in laparoscopic cholecystectomy: all possible complications

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Abstract

Background

Laparoscopic cholecystectomy (LC) has been the gold standard for symptomatic gallstones for 15 years. During that time, several studies and case reports have been published which outline the possible complications of lost gallstones. The aim of this review is to categorize these complications and to evaluate the frequency and management of lost gallstones.

Data Sources

A Medline search from 1987 to 2005 was performed. A total of 111 case reports and studies were found, and all reported complications were listed alphabetically. Eight studies with more than 500 LCs that reported lost gallstones and perforated gallbladder were analyzed for frequency and management of lost gallstones.

Conclusion

Lost gallstones have a low incidence of causing complications but have a large variety of possible postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory.

Section snippets

Methods

A systematic literature search in the NCBI National Library of Medicine (Pub Med; January 1987–January 2005) was conducted by the senior author (J.Z.). As mentioned in Brockmann et al [1], a systemic review according to the Cochrane recommendations is not possible because of the limitations of the primary literature.

A search strategy was set up using the following text words and combinations (Boolean operators): abscess, bile, fistula, lost gallstones, spilled gallstones, spilt gallstone,

List of possible complications

A total of 111 case reports and studies were found with documented complications after gallstone spillage or lost gallstones after LC. A list of possible complications categorized alphabetically with the references as mentioned in MEDLINE was created (Table 1). The most frequently reported complication was an abscess in the abdominal wall as a consequence of lost gallstones, which was mentioned in 16 case reports or studies. Intra-abdominal abscess was mentioned in 15 publications. Also,

Comments

The aim of the study was to perform a systemic literature search in order to alphabetically categorize complications of lost gallstones from LC. We found that the most published complications, like intra-abdominal abscesses and abscesses of the abdominal wall, followed by subhepatic and subphrenic abscesses, are likely the most frequent ones.

Another common complication is fistula formation, which occurs across a broad spectrum, ranging from fistulas of the skin or umbilicus to colocutaneous or

Summary

Lost gallstones have a low incidence of causing complications but have a large variety of different postoperative problems. Every effort should be made to remove spilled gallstones to prevent further complications, but conversion is not mandatory. Open or laparoscopic removal of lost gallstones with abscess formation should be preferred to interventional drainage. [29], [30], [31], [32], [35], [36].

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