ABSTRACT
Cholecystectomies are one of the commonest surgeries done in India. Gallbladder perforation and stone spillage is common and occurs in 15 to 40% of laparoscopic and 5 to 20% of open cholecystectomy procedures. In up to a third of these cases, stones are not retrieved and complications can arise many years post-operatively. In majority of cases these lost stones either in laparoscopic or open surgery remain silent but rarely can become symptomatic and cause range of complications like intra-abdominal abscesses, empyema, abdominal wall abscesses, cutaneous sinus tract and bladder fistulas. Diagnosis can be difficult and patients may present to many specialties within medicine and surgery. We seek to present our case and on a rare complication and management of one such “lost” stone.
ABSTRACT
Objective:To evaluate the value of intraoperative transcystic cholangiography(IOC) during laparoscopic cholecystectomy(LC).Methods:IOC was conducted in 56 patients who underwent LC because of cholelithiasis with chronic or acute cholecystitis and biliary pancreatitis.The results were analyzed.Results:Cannulation was successfully completed in 54 out of 56 patients,and the success rate was 96.4%.All 54 patients underwent satisfactory visualization.The common bile duct stones were detected in 5 patients by IOC,and 2 of them were converted to common bile duct exploration and T-tube drainage by open cholecystectomy;3 of them were converted to common bile duct exploration and T-tube drainage by laparoscopic cholecystectomy.2 cases were found to have abnormal cystic duct by IOC,and 4 cases were detected for the biliary anatomy by IOC.The average time of IOC was about(15.5?3.7)minutes.No complication occurred.Conclusion:IOC is a safe and convenient procedure with a high success rate,and it can provide clear films of biliary tree.The benefit of IOC is the detection of common bile duct and cystic duct stones and abnormal biliary anatomy.It can reduce the rate of retained common bile duct stones and bile duct injuries,and increase the early identification of bile duct injuries.Therefore IOC can improve quality and security of LC.