Journal article
Current Evidence on the Diagnosis and Management of Spilled Gallstones Post-laparoscopic Cholecystectomy
Journal of gastrointestinal surgery, Vol.28(12), pp.2125-2133
12/2024
DOI: 10.1016/j.gassur.2024.10.001
PMID: 39370097
Abstract
Despite improvements in intraoperative and postoperative outcomes of laparoscopic cholecystectomy (LC), spilled gallstones after LC remains a significant yet often overlooked complication, occurring around 1-40% of cases. This review discusses the most recent updates in risk factors, presentations, complications, diagnosis, management, and prognosis for spilled gallstones post-LC.
A comprehensive systematic review was performed using Medline/PubMed, Google Scholar, Cochrane Library, and the Web of Science databases, with the range of search date being between Jan 2015 and July 2024, regarding spilled gallstone incidence, management, and complications.
Risk factors for spilled gallstones (SG) post-LC are intraoperative gallbladder perforation due to poor operational environment, quantity, size, type of stones (pigment, cholesterol-rich, or mixed), presence of adhesions or anatomic variations, and insufficient surgical training. 60% of SG complications are abscesses from bacterial infections, which can progress to peritonitis, fistulas, lung/liver abscesses, and choledocholithiasis. SGs are associated with delayed presentation of unexpected clinical problems, with even diagnosis. Although treatment depends on the severity of the complication, when SGs are identified through imaging, often through ultrasound (US) and computed tomography, minimally invasive approaches and antibiotic courses are viable first-line approaches.
Although LC-associated spillage of gallstones are rare, the complications can be a serious cause of morbidity. Therefore, having proper notification of operative complications, a high index of suspicion for patients with prior history of LC, and awareness of proper diagnostic modalities is key to early diagnosis and prevention of SG-related complications.
Details
- Title: Subtitle
- Current Evidence on the Diagnosis and Management of Spilled Gallstones Post-laparoscopic Cholecystectomy
- Creators
- Hassan Aziz - University of IowaYe In Christopher Kwon - Virginia Commonwealth UniversityKerry Yi Chen Lee - Virginia Commonwealth UniversityAndrew Min-Gi Park - Virginia Commonwealth UniversityAlan Lai - Virginia Commonwealth UniversityYeseo Kwon - Tufts UniversityAshant Yaswani - University of Iowa Hospitals and ClinicsTimothy M. Pawlik - The Ohio State University Wexner Medical Center
- Resource Type
- Journal article
- Publication Details
- Journal of gastrointestinal surgery, Vol.28(12), pp.2125-2133
- DOI
- 10.1016/j.gassur.2024.10.001
- PMID
- 39370097
- NLM abbreviation
- J Gastrointest Surg
- ISSN
- 1091-255X
- eISSN
- 1873-4626
- Publisher
- Elsevier Inc
- Language
- English
- Electronic publication date
- 10/04/2024
- Date published
- 12/2024
- Academic Unit
- Surgery
- Record Identifier
- 9984723056202771
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