Unusual abscess pattern following dropped gallstones during laparoscopic cholecystectomy

ABSTRACT

Laparoscopic Cholecystectomy has become the standard treatment for symptomatic cholelithiasis. Numerous clinical trials have deemed it a safe procedure, regardless of the known increased risk of bile duct injury. However, the consequences and incidence of less well-known complications are still being addressed. Between 1995 and 1998, 200 laparoscopic cholecystectomy were performed at El-Minia Surgical Department, 3 patients [1.5 percent] subsequently developed abscesses as a consequence of dropped stones during the Laparoscopic Cholecystectomy, while 2 [1 percent] other patients developed trocar site "tumor" masses that were secondary to inflammatory tissue around gallstone fragments. All patients were successfully treated by surgical drainage, stone removal, and antibiotics. Trocar site inflammatory masses required excision only. This experience closely resembles that of the other centers and points out the existence of late postoperative complications following laparoscopic cholecystectomy that was rarely encountered with open cholecystectomy. Strategies from avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrigation at time of surgery with or without placement of a drain in the subhepatic space does not prevent this complication