Ultrasonographic and radiologic evaluation of patients after laparoscopic cholecystectomy

The first 30 patients scheduled to undergo laparoscopic cholecystectomy at the Kingston General Hospital, Kingston, Ont., were studied by abdominal ultrasonography and abdominal roentgenography 24 hours after the procedure. The ultrasonogram appeared normal in 21 of the 29 patients in whom laparoscopic cholecystectomy was successful. In six of the eight patients with an abnormal ultrasonogram a tiny collection of fluid was identified in the gallbladder fossa; in two patients retained intraperitoneal stones were identified (one of these patients also had a small fluid loculus); and one patient had a small amount of free fluid in Morrison's pouch. This last patient was subsequently found to have a retained common-bile-duct stone, which required endoscopic removal. Plain films showed moderate to large amounts of retained gas intraperitoneally in only three patients. Colonic distension was recorded in 23 of the 28 patients studied, suggesting a partial colonic ileus. Residual pneumoperitoneum and colonic distension did not correlate with any untoward clinical findings. This study demonstrates that most patients have complete reabsorption of their pneumoperitoneum within 24 hours of laparoscopic cholecystectomy and that small amounts of fluid in the gallbladder fossa and mild to moderate colonic distension are not significant in terms of operative complications.