The need to retrieve the dropped stone during laparoscopic cholecystectomy

Area of Science:

• Surgical Pathology
• Experimental Surgery
• Gastrointestinal Surgery

Background:

• Gallstones are common, and their accidental loss into the peritoneal cavity during cholecystectomy can lead to complications.
• The effects of bile and gallstones on the peritoneum are not fully understood.
• Understanding these effects is crucial for preventing post-operative complications.

Purpose of the Study:

• To investigate the impact of bile and gallstones on the peritoneal cavity in an experimental animal model.
• To determine the risk of adhesion and abscess formation when bile and gallstones are present intraperitoneally.
• To provide evidence supporting the importance of retrieving lost gallstones during surgery.

Main Methods:

• Ninety male Sprague-Dawley rats were divided into six groups.
• Groups received intraperitoneal injections of saline, sterile bile, or infected bile.
• Other groups involved surgical procedures with gallstone placement and bile/saline injection.
• Animals were observed for 4 weeks, followed by examination of the peritoneal cavity.

Main Results:

• No intra-abdominal lesions were observed in control groups receiving only saline or bile.
• Significant adhesion formation (73% and 67%) occurred in groups with both gallstones and bile.
• Two intra-abdominal abscesses were noted in the group with gallstones and infected bile.
• No lesions were found in the laparotomy-only control group.

Conclusions:

• Intraperitoneal bile combined with gallstones significantly increases the risk of intra-abdominal adhesions.
• The presence of bile and gallstones may also lead to abscess formation.
• Minimizing gallstone spillage during cholecystectomy is essential to prevent these adverse outcomes.