Skip to main content
Download PDF

Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review

World Journal of Emergency Surgery volume 17, Article number: 57 (2022) Cite this article

Abstract

Introduction

Complications secondary to spilled gallstones can be classified in the category of disease of medical progress because prior to advent of laparoscopic cholecystectomy very few reports published on the topic. The aim of the present study was to investigate the predisposing factors and the complication rate of spilled gallstones during laparoscopic cholecystectomy over the past 21 years.

Methods

Embase, Pubmed, Medline, Google scholar and Cochrane library were systematically searched for pertinent literature.

Results

Seventy five out of 181 articles were selected including 85 patients; of those 38% were men and 62% women. The median age of the cohort was 64 years old and ranged between 33 and 87 years. Only 23(27%) of the authors reported the incident of spillage of the gallstones during the operation. Time of onset of symptoms varied widely from the second postoperative day to 15 years later. Ten of 85 patients were asymptomatic and diagnosed with spilled gallstones incidentally. The rest of the patients presented with complications of severe morbidity and almost, 87% of the patients needed to be treated with surgical intervention and 12% with US ± CT scan guidance drainage. Only one perioperative death reported.

Conclusions

Symptomatic patients with lost gallstones present with severe morbidity complications and required mostly major surgical procedures. Therefore, standardisation of the management of spilled gallstones is needed urgently. Hospitals need to review their policy with audits and recommendations and clinical guidelines are needed urgently.

Introduction

Since 1992, laparoscopic cholecystectomy accepted as a treatment of choice for symptomatic cholelithiasis by consensus statement from the National Institute of health conference [1]. It has been reported that the incidence rate of perforation of gallbladder during laparoscopic cholecystectomy (LC) ranges from 6 to 40% [2, 3]. The incidence rate of spillage of gallstones secondary to perforation reported 16% [4]. In addition, 16 to 50% of spilled stones remained un-retrieved [4, 5]. They may migrate in different regions and the reported complication rate varies from 0.08 to 0.3% [6]. However, most recent evidence reported that the incidence rate of complications of spilled gallstones may ranges from 0.04 to 19% [7]. The management of the spilled gallstones varies widely. Notably, studies which analyse complications of the LCs did not mention perforation of the gallbladder and spillage of stones as complication [8]. In addition, a study from the UK reported that only one fifth of the surgeons document spillage of the gallstones as a potential complication in the consent form. Moreover, only half of them in case of spillage and un-retrieved stones inform the patient. They are reluctant to do that because this may lead to unnecessary stress and repeated examinations for presumed complications of low risk [9]. However, most recent evidence demonstrated that gallbladder perforation and spillage of stones may lead to complications of severe morbidity. In particular, acute cases, older age, male sex, number of spilled stones more than 15 with diameter > 1.5 cm, pigment stones and perihepatic localisation are predicting factors for developing severe complications [3].

Because of lack of consensus recommendations and guidelines the management of spilled gallstones vary widely between institutions and individual surgeons. Therefore, the need for further evaluation of the accumulated evidence is needed urgently.

The aim of the present study was to evaluate the evidence of the complications rate of the spilled gallstones overtime by conducting a systematic review.

Methods

Literature search strategy

From 2000 until today a literature search was performed in Embase, Medline (Pubmed), Cochrane library, Google scholar, and National Institute for Health and clinical Excellence (NICE) databases using free and MeSH terms (spilled, lost gallstones, complications during laparoscopic cholecystectomy, late complications after laparoscopic cholecystectomy, intraabdominal abscess, retroperitoneal abscess, flank abscess, pigment gallstones, cholesterol gallstones). The search strategy was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [10].

Study, selection, and inclusion and exclusion criteria

Publications evaluating the complications of spilled gallstones during laparoscopic cholecystectomy were included. Studies referred to open cholecystectomy and editorials without original data were excluded.

Data extraction and outcomes

Two reviewers (PG and NDA) independently extracted the following data from the included studies: name of authors, country, year of publication, age, gender, indication for laparoscopic cholecystectomy, reference to spilled gallstones, type of lost stones, number of stones spilled, size of lost stones, location of lost stones, presenting symptoms, time of onset of symptoms after the laparoscopic cholecystectomy, complications caused by lost stones and location found, type of reintervention, 90-day perioperative mortality.

Results

Seventy-five articles from a pool of 181 articles were selected including 85 patients [11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85], (Fig. 1, Table 1). The median age of the cohort was 64 years and ranged between 33 and 87 years. The percentage of males and females were of 38% and 62%, respectively. The acute cases were 26(31%). Only 23(27%) of the surgeons reported the perforation of the gallbladder and consequently, spillage of the gallstones in the operative notes. The median time of onset of symptoms was 36 months and ranged between 1 and 180 months; the mode was 24 months. The most common site of lost stones was the right subhepatic, perihepatic, retroperitoneal, right flank and pelvis. Ten (12%) out of 85 cases of lost stones discovered incidentally [18, 19, 23, 39, 47, 49, 52, 58, 71, 75]. Type of lost gallstones discovered during the re-intervention reported by 17 authors(20%), [18,19,20, 24, 31, 35, 39, 42, 43, 53, 54, 63, 80]; of those 7 (41%) were pigment and 8 (47%) cholesterol gallstones. Seventeen(20%) of authors reported the number of discovered gallstones [18, 25, 27,28,29, 31, 35, 38, 39, 44, 45, 50, 54, 57, 70, 80, 83]. The size of discovered gallstones was reported by 12(14.11%) authors [18, 19, 25, 28, 31, 35, 37, 52, 63]. The most prevalent presenting symptoms were pain, fever, nausea, vomiting, abdominal swelling, fistula formation, and loss of weight. The most prevalent complications were intrabdominal abscesses 31(36.5%), abdominal wall abscesses 9(10.6%), retroperitoneal abscesses 8(9.4%), thus abscesses in total consisted of 48(56.5%) cases. Notably, 87% of patients underwent a surgical procedure and 12% treated with US ± CT scan guidance drainage, two cases that diagnosed incidentally and were asymptomatic scheduled for regular follow-ups (Table 1). One patient died on the 11th postoperative day after lung decortication for thoracic empyema secondary to lost gallstones [15].

Fig. 1
figure 1

Diagram of the search strategy

Full size image
Table 1 Study characteristics of the publications for the complications of the spilled gallstones
Full size table

Discussion

Complications of the spilled gallstones can be described under the umbrella eponym, disease of the medical progress DOMP. There is a contrasting difference with the open cholecystectomy; because spillage of gallstones during open cholecystectomy is more easier identified and retrieved there are very few reports with the above complication [86, 87].

At the present 96% of all cholecystectomies are performed laparoscopically [88]. In general, the characteristics of the cohorts of patients who underwent laparoscopic and open cholecystectomies differ essentially. The laparoscopic cohort is consisted of younger and healthier patients whereas the open cohort tend to be older, less well, and generally the open cholecystectomy is performed in higher-risk patients [89, 90]. Another important characteristic of the laparoscopic era is the broadening of the indications and the dramatic increase in the number of LCs performed for acalculous disease [91].

Taking into account that present studies reported that older age is a predicting factor for developing complications following spillage of gallstones [3]. We can see a controversy with the above evidence that demonstrates that the LC cohort includes younger and healthier patients. Therefore, there is a strong indication for further investigation and identification of the co-factors (e. g comorbidities, type of gallstones, acute vs chronic cases) that predispose to above complication. In the present study the median age was 64 years and varied widely from 33 to 87 years (Table 1).

An analysis performed at American College of Surgeons-National Surgical Quality Improvement Program hospitals found the rates of severe morbidity of laparoscopic and open cholecystectomy to be 1.4% and 11.1%, respectively [92].

Notably, the Swiss Association of Laparoscopic and Thoracoscopic Surgeons (SALTS) database defined the rates following LC for patients only with diagnosis of acute or chronic cholecystitis for intraoperative complications at 7%, postoperative local complications at 4%, and postoperative systemic complications at 2.3% [93]. The above comparison demonstrates that when the investigation is further focused to acute vs chronic cases the incidence rate of severe morbidity of LC increases dramatically from 1.4 to 7% [92, 93]. Although, it is reported that the acute cholecystitis is predisposing factor for complications of spilled gallstones [3]; in the present study only 31% were the acute cases. Therefore, future studies need to shed further light on the above topic. Moreover, in the present study, only 23(27%) of the surgeons reported the incidence of gallbladder perforation and spillage of gallstones in the operative notes. Furthermore, Mullerat et al. reported that only one fifth of the surgeons included in the consent form spillage of the gallstones as a potential complication. In addition, if this occurred during the operation they do not report it to GPs and patient because they consider it an innocent complication; although this information is going to help colleagues to resolve future diagnostic dilemmas [9].

Although, it is reported that the number of spilled gallstones more than 15, size > 1.5 cm and pigment type gallstones are predicting factors of complications of spilled gallstones [3]; in the present study, type of lost gallstones, number, and size of discovered gallstones during the re-intervention reported at 17(20%), 17(20%), and 12(14,11%), respectively. In particular, pigmented and cholesterol gallstones consisted 41% and 47%, respectively. Therefore, future studies should be more meticulous regarding describing type, size, and number of discovered gallstones because the accumulated information will further help describing in details the predicting risk factors and furthermore, this will help in the standardisation of the management of spilled gallstones.

The median time to onset of symptoms was 36 months and ranged from 1 to 180 months. It is obvious that was ranged widely. Considering the above finding and the widely ranged follow-up, the results of the incidence rates of complications should be treated cautiously because time, follow-up, and institutions bias might have influenced the results.

Notably, vast majority of the cases of undiscovered gallstones required open intervention. In particular, 61(72%) patients underwent open surgery and 13(15%) patient laparoscopic procedure, 9(11%) treated either with US and/or CT scan guided drainage. Two cases that detected early postoperatively and were asymptomatic scheduled for regular follow-ups. These finding underlines that although the incidence rate of the complications is low when they become symptomatic the treatment of choice is surgical intervention Therefore, there is urgent need for standardisation and clinical guidelines for the management of spilled gallstones.

Limitations

The results of the present study should be treated cautiously because all the included studies were case reports. Therefore, institutional, national, underpowered sample size, learning curve, performance and follow-up bias might have influenced the results. Another topic that needs special attention is the incidence rate. Usually, the cases with most complicated presentation and with worst outcomes published as case reports. On the contrary cases with mild symptoms and better outcomes, usually are not publishable. Therefore, an international registry and audit may help to define precisely the incidence rate, and severity of complications of spilled gallstones.

Conclusions

The current evidence demonstrates that although the incidence rate of complications varies widely the majority of the patients demonstrated severe morbidity and required surgical interventions. Therefore, urgent standardisation of the management of spilled gallstones is needed. Surgeons must document all cases of spilled stones in the operative notes. Moreover, GPs and patients should be informed about the incidence, this will help to resolve diagnostic dilemmas in the future. Hospitals should review their policy by conducting audits and surgical societies should use the above information and national databases in order urgently to formulate clinical guidelines.

Availability of data and materials

The authors declare that data supporting the findings of this study are available within the article.

References

  1. Gallstones and Laparoscopic Cholecystectomy. NIH Conse Statement 1992, 10:1–20. http://www.ncbi.nlm.nih.gov/pubmed/1301217

  2. Soper NJ, Dunnegan DL. Does intraoperative gallbladder perforation influence the early outcome of laparoscopic cholecystectomy? Surg Laparosc Endosc. 1991;1(3):156–61 (PMID: 1669395).

    CAS  PubMed  Google Scholar 

  3. Brockmann JG, Kocher T, Senninger NJ, Schürmann GM. Complications due to gallstones lost during laparoscopic cholecystectomy. Surg Endosc. 2002;16(8):1226–32. https://doi.org/10.1007/s00464-001-9173-8.

    Article  CAS  PubMed  Google Scholar 

  4. Diez J, Arozamena C, Gutierrez L, Bracco J, Mon A, Sanchez Almeyra R, Secchi M. Lost stones during laparoscopic cholecystectomy. HPB Surg. 1998;11(2):105–9. https://doi.org/10.1155/1998/95874.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Sarli L, Pietra N, Costi R, Grattarola M. Gallbladder perforation during laparoscopic cholecystectomy. World J Surg. 1999;23(11):1186–90. https://doi.org/10.1007/s002689900644 (PMID: 10501883).

    Article  CAS  PubMed  Google Scholar 

  6. Sathesh-Kumar T, Saklani AP, Vinayagan R, Blackett RL. Spilled gallstones during laparoscopic cholecystectomy: a review of the literature. Postgrad Med J. 2004;80:77–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Jabbari Nooghabi A, Hassanpour M, Jangjoo A. Consequences of lost gallstones during laparoscopic cholecystectomy: a review article. Surg Laparosc Endosc Percutan Tech. 2016;26:183–92.

    Article  PubMed  Google Scholar 

  8. Atabek U, Spence RK, Manigat Y, Barse F, Leese KH, Davies R, Vilanueva D, Camishion RC. Documentation of abdominal exploration during laparoscopic cholecystectomy. Surg Endosc. 1995;9(1):22–4. https://doi.org/10.1007/BF00187879.

    Article  CAS  PubMed  Google Scholar 

  9. Mullerat J, Cooper K, Box B, Soin B. The case for standardisation of the management of gallstones spilled and not retrieved at laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2008;90:310–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(6):e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Ray S, Kumar D, Garai D, Khamrui S. Dropped gallstone-related right subhepatic and parietal wall abscess: a rare complication after laparoscopic cholecystectomy. ACG Case Rep J. 2021;8(5):e00579.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mehmood S, Singh S, Igwe C, Obasi CO, Thomas RL. Gallstone extraction from a back abscess resulting from spilled gallstones during laparoscopic cholecystectomy: a case report. J Surg Case Rep. 2021. https://doi.org/10.1093/jscr/rjab293.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Guruvaiah N, Ponnatapura J. Bronchobiliary fistula: a rare postoperative complication of spilled gallstones from laparoscopic cholecystectomy. BMJ Case Rep. 2021;14(7):e243198. https://doi.org/10.1136/bcr-2021-243198.

    Article  PubMed  Google Scholar 

  14. Djelassi S, Vandenbroucke F, Schoneveld M. A curious case of recurrent abdominal wall infections. J Belg Soc Radiol. 2021;105(1):12. https://doi.org/10.5334/jbsr.2387.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tchercansky AN, Fernandez Alberti J, Panzardi N, Auvieux R, Buero A. Thoracic empyema after gallstone spillage in times of Covid. Int J Surg Case Rep. 2020;76:221–6. https://doi.org/10.1016/j.ijscr.2020.09.181.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kafadar MT, Çetinkaya İ, Aday U, Başol Ö, Bilge H. Acute abdomen due to spilled gallstones: a diagnostic dilemma 10 years after laparoscopic cholecystectomy. J Surg Case Rep. 2020;2020(8):rjaa275. https://doi.org/10.1093/jscr/rjaa275.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Marçal A, Pereira RV, Monteiro A, Dias J, Oliveira A, Pinto-de-Sousa J. Right lumbar abscess containing a gallstone-an unexpected late complication of laparoscopic cholecystectomy. J Surg Case Rep. 2020;2020(7):rjaa248. https://doi.org/10.1093/jscr/rjaa248.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Bolat H, Teke Z. Spilled gallstones found incidentally in a direct inguinal hernia sac: report of a case. Int J Surg Case Rep. 2020;66:218–20. https://doi.org/10.1016/j.ijscr.2019.12.018.

    Article  PubMed  Google Scholar 

  19. Heywood S, Wagstaff B, Tait N. An unusual site of gallstones five years after laparoscopic cholecystectomy. Int J Surg Case Rep. 2019;56:107–9. https://doi.org/10.1016/j.ijscr.2019.02.038.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Cummings K, Khoo T, Pal T, Psevdos G. Recurrence of Citobacter koseri-associated intra-abdominal infection 2 years after spilled gallstones during laparoscopic cholecystectomy. J Global Infect Dis. 2019;11:47–9.

    Article  Google Scholar 

  21. Akhtar A, Bukhari MM, Tariq U, Sheikh AB, Siddiqui FS, Sohail MS, Khan A. Spilled gallstones silent for a decade: a case report and review of literature. Cureus. 2018;10(7):e2921. https://doi.org/10.7759/cureus.2921.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tyagi V, Wiznia DH, Wyllie AK, Keggi KJ. Total hip lithiasis: a rare sequelae of spilled gallstones. Case Rep Orthop. 2018;14(2018):9706065. https://doi.org/10.1155/2018/9706065.

    Article  Google Scholar 

  23. Capolupo GT, Mascianà G, Carannante F, Caricato M. Spilled gallstones simulating peritoneal carcinomatosis: a case report and literature review. Int J Surg Case Rep. 2018;48:113–21. https://doi.org/10.1016/j.ijscr.2018.04.016.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Urade T, Sawa H, Murata K, Mii Y, Iwatani Y, Futai R, Abe S, Sanuki T, Morinaga Y, Kuroda D. Omental abscess due to a spilled gallstone after laparoscopic cholecystectomy. Clin J Gastroenterol. 2018;11(5):433–6. https://doi.org/10.1007/s12328-018-0853-5.

    Article  PubMed  Google Scholar 

  25. Ologun GO, Lovely R, Sultany M, Aman M. Retained gallstone presenting as large intra-abdominal mass four years after laparoscopic cholecystectomy. Cureus. 2018;10(1):e2030. https://doi.org/10.7759/cureus.2030.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Stroobants E, Cools P, Somville F. Case report: an unwanted leftover after laparoscopic cholecystectomy. Acta Chir Belg. 2018;118(3):196–8. https://doi.org/10.1080/00015458.2017.1346035.

    Article  PubMed  Google Scholar 

  27. Kaplan U, Shpoliansky G, Abu Hatoum O, Kimmel B, Kopelman D. The lost stone - laparoscopic exploration of abscess cavity and retrieval of lost gallstone post cholecystectomy: a case series and review of the literature. Int J Surg Case Rep. 2018;53:43–5. https://doi.org/10.1016/j.ijscr.2018.10.020.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Koichopolos J, Hamidi M, Cecchini M, Leslie K. Gastric outlet obstruction by a lost gallstone: case report and literature review. Int J Surg Case Rep. 2017;41:128–31. https://doi.org/10.1016/j.ijscr.2017.10.014.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Canna A, Adaba F, Sezen E, Bissett A, Finch GJ, Ihedioha U. Para-spinal abscess following gallstones spillage during laparoscopic cholecystectomy: an unusual presentation. J Surg Case Rep. 2017. https://doi.org/10.1093/jscr/rjx052.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Lentz J, Tobar MA, Canders CP. Perihepatic, pulmonary, and renal abscesses due to spilled gallstones. J Emerg Med. 2017;52(5):e183–5. https://doi.org/10.1016/j.jemermed.2016.12.016.

    Article  PubMed  Google Scholar 

  31. Faour R, Sultan D, Houry R, Faour M, Ghazal A. Gallstone-related abdominal cystic mass presenting 6 years after laparoscopic cholecystectomy: a case report. Int J Surg Case Rep. 2017;32:70–2. https://doi.org/10.1016/j.ijscr.2017.01.059.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ragozzino A, Puglia M, Romano F, Imbriaco M. Intra-hepatic spillage of gallstones as a late complication of laparoscopic cholecystectomy: MR imaging findings. Pol J Radiol. 2016;10(81):322–4. https://doi.org/10.12659/PJR.896497.

    Article  Google Scholar 

  33. Kim BS, Joo SH, Kim HC. Spilled gallstones mimicking a retroperitoneal sarcoma following laparoscopic cholecystectomy. World J Gastroenterol. 2016;22(17):4421–6. https://doi.org/10.3748/wjg.v22.i17.4421.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Goodman LF, Bateni CP, Bishop JW, Canter RJ. Delayed phlegmon with gallstone fragments masquerading as soft tissue sarcoma. J Surg Case Rep. 2016;2016(6):rjw106. https://doi.org/10.1093/jscr/rjw106.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Moga D, Perişanu Ș, Popenţiu A, Sora D, Magdu H. Right retroperitoneal and subhepatic abscess late complications due to spilled stones during laparoscopic cholecystectomy - case report. Chirurgia. 2016;111(1):67–70.

    PubMed  Google Scholar 

  36. Bedell SL, Kho KA. Spilled gallstones after laparoscopic cholecystectomy associated with pelvic pain. Am J Obstet Gynecol. 2015;213(3):432.e1-2. https://doi.org/10.1016/j.ajog.2015.04.020.

    Article  Google Scholar 

  37. Binagi S, Keune J, Awad M. Immediate postoperative pain: an atypical presentation of dropped gallstones after laparoscopic cholecystectomy. Case Rep Surg. 2015;2015:930450. https://doi.org/10.1155/2015/930450.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Grass F, Fournier I, Bettschart V. Abdominal wall abscess after cholecystectomy. BMC Res Notes. 2015;5(8):334. https://doi.org/10.1186/s13104-015-1303-9.

    Article  Google Scholar 

  39. Noda Y, Kanematsu M, Goshima S, Kondo H, Watanabe H, Kawada H, Kawai N, Tanahashi Y. Peritoneal chronic inflammatory mass formation due to gallstones lost during laparoscopic cholecystectomy. Clin Imaging. 2014;38(5):758–61. https://doi.org/10.1016/j.clinimag.2014.03.011.

    Article  PubMed  Google Scholar 

  40. Ahmad J, Mayne AI, Zen Y, Loughrey MB, Kelly P, Taylor M. Spilled gallstones during laparoscopic cholecystectomy. Ann R Coll Surg Engl. 2014;96(5):e18-20. https://doi.org/10.1308/003588414X13946184900444.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Lee W, Kwon J. Fate of lost gallstones during laparoscopic cholecystectomy. Korean J Hepato-Biliary-Pancreat Surg. 2013;17(2):66. https://doi.org/10.14701/kjhbps.2013.17.2.66.

    Article  Google Scholar 

  42. Morris MW, Barker AK, Harrison JM, Anderson AJ, Vanderlan WB. Cicatrical cecal volvulus following laparoscopic cholecystectomy. JSLS. 2013;17(2):333–7. https://doi.org/10.4293/108680813X13654754534314.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Peravali R, Harris A. Laparoscopic management of chronic abscess due to spilled gallstones. JSLS. 2013;17(4):657–60. https://doi.org/10.4293/108680813X13654754535313.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Dobradin A, Jugmohan S, Dabul L. Gallstone-related abdominal abscess 8 years after laparoscopic cholecystectomy. JSLS. 2013;17(1):139–42. https://doi.org/10.4293/108680812X13517013317518.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Chatzimavroudis G, Atmatzidis S, Papaziogas B, Galanis I, Koutelidakis I, Doulias T, Christopoulos P, Papadakis G, Atmatzidis K, Makris J. Retroperitoneal abscess formation as a result of spilled gallstones during laparoscopic cholecystectomy: an unusual case report. Case Rep Surg. 2012;2012:573092. https://doi.org/10.1155/2012/573092.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Gorospe L. Intraperitoneal spilled gallstones presenting as fever of unknown origin after laparoscopic cholecystectomy: FDG PET/CT findings. Clin Nucl Med. 2012;37(8):819–20. https://doi.org/10.1097/RLU.0b013e31824c6042.

    Article  PubMed  Google Scholar 

  47. Anrique D, Kroker A, Ebert AD. “Blueberry Sign”: spilled gallstones after cholecystectomy as an uncommon finding. J Minim Invasive Gynecol. 2013;20(3):329. https://doi.org/10.1016/j.jmig.2012.11.011.

    Article  PubMed  Google Scholar 

  48. Arai T, Ikeno T, Miyamoto H. Spilled gallstones mimicking a liver tumor. Clin Gastroenterol Hepatol. 2012;10(11):A32. https://doi.org/10.1016/j.cgh.2012.06.026s.

    Article  PubMed  Google Scholar 

  49. Papadopoulos IN, Christodoulou S, Economopoulos N. Asymptomatic omental granuloma following spillage of gallstones during laparoscopic cholecystectomy protects patients and influences surgeons’ decisions: a review. Case Rep. 2012;2012(jan23 1):bcr1020114980–bcr1020114980. https://doi.org/10.1136/bcr.10.2011.4980.

    Article  Google Scholar 

  50. Singh K, Wang ML, Ofori E, Widmann W, Alemi A, Nakaska M. Gallstone abscess as a result of dropped gallstones during laparoscopic cholecystectomy. Int J Surg Case Rep. 2012;3(12):611–3. https://doi.org/10.1016/j.ijscr.2012.07.017.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Rammohan A, Srinivasan UP, Jeswanth S, Ravichandran P. Inflammatory pseudotumour secondary to spilled intra-abdominal gallstones. Int J Surg Case Rep. 2012;3(7):305–7. https://doi.org/10.1016/j.ijscr.2012.03.013.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Kayashima H, Ikegami T, Ueo H, Tsubokawa N, Matsuura H, Okamoto D, Nakashima A, Okadome K. Inflammatory pseudotumor of the liver in association with spilled gallstones 3 years after laparoscopic cholecystectomy: report of a case. Asian J Endosc Surg. 2011;4(4):181–4. https://doi.org/10.1111/j.1758-5910.2011.00094.x.

    Article  CAS  PubMed  Google Scholar 

  53. Hussain MI, Al-Akeely MH, Alam MK, Al-Abood FM. Abdominal wall abscess following laparoscopic cholecystectomy: an unusual late complication of lost gallstones. J Coll Phys Surg Pak. 2010;20(11):763–5.

    Google Scholar 

  54. Pottakkat B, Sundaram M, Singh P. Abdominal wall abscess due to spilled gallstone presenting 11 years after laparoscopic cholecystectomy. Clin J Gastroenterol. 2010;3(6):324–6. https://doi.org/10.1007/s12328-010-0180-y.

    Article  PubMed  Google Scholar 

  55. Bouasker I, Zoghlami A, El Ouaer MA, Khalfallah M, Samaali I, Dziri C. Abcès pariétal fistulisé révèlant des calculs oubliés huit ans après une cholécystectomie laparoscopique [Parietal abscess revealing a lost gallstone 8 years after laparoscopic cholecystectomy]. Tunis Med. 2010;88(4):277–9.

    PubMed  Google Scholar 

  56. Gooneratne DL. A rare late complication of spilled gallstones. N Z Med J. 2010;123(1318):62–6.

    PubMed  Google Scholar 

  57. Helme S, Samdani T, Sinha P. Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview. J Med Case Rep. 2009;24(3):8626. https://doi.org/10.4076/1752-1947-3-8626.

    Article  Google Scholar 

  58. Morishita K, Otomo Y, Sasaki H, Yamashiro T, Okubo K. Multiple abdominal granuloma caused by spilled gallstones with imaging findings that mimic malignancy. Am J Surg. 2010;199(2):e23–4. https://doi.org/10.1016/j.amjsurg.2009.04.016.

    Article  PubMed  Google Scholar 

  59. Dasari BV, Loan W, Carey DP. Spilled gallstones mimicking peritoneal metastases. JSLS. 2009;13(1):73–6.

    PubMed  PubMed Central  Google Scholar 

  60. Maempel J, Darmanin G, Paice A, Uzkalnis A. An unusual “hernia”: losing a stone is not always a good thing! BMJ Case Rep. 2009. https://doi.org/10.1136/bcr.12.2008.1321.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Hougård K, Bergenfeldt M. Abdominalfistel syv år efter kolecystektomi [Abdominal fistula 7 years after laparoscopic cholecystectomy]. Ugeskr Laeger. 2008;170(36):2803.

    PubMed  Google Scholar 

  62. Arishi AR, Rabie ME, Khan MS, Sumaili H, Shaabi H, Michael NT, Shekhawat BS. Spilled gallstones: the source of an enigma. JSLS. 2008;12(3):321–5.

    PubMed  PubMed Central  Google Scholar 

  63. de Hingh IH, Gouma DJ. Diagnose in beeld (345). Een vrouw met buikpijn en vaginaal pusverlies [Diagnostic image (345). A woman with abdominal pain and purulent vaginal discharge]. Ned Tijdschr Geneeskd. 2007;151(41):2271.

    PubMed  Google Scholar 

  64. Stupak D, Cohen S, Kasmin F, Lee Y, Siegel JH. Intra-abdominal actinomycosis 11 years after spilled gallstones at the time of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2007;17(6):542–4. https://doi.org/10.1097/SLE.0b013e3181469069.

    Article  PubMed  Google Scholar 

  65. Pantanowitz L, Prefontaine M, Hunt JP. Cholelithiasis of the ovary after laparoscopic cholecystectomy: a case report. J Reprod Med. 2007;52(10):968–70.

    PubMed  Google Scholar 

  66. Wehbe E, Voboril RJ, Brumfield EJ. A spilled gallstone. Med J Aust. 2007;187(7):397. https://doi.org/10.5694/j.1326-5377.2007.tb01310.x.

    Article  PubMed  Google Scholar 

  67. Wittich AC. Spilt gallstones removed after one year through a colpotomy incision: report of a case. Int Surg. 2007;92(1):17–9.

    PubMed  Google Scholar 

  68. Bhati CS, Tamijmarane A, Bramhall SR. A tale of three spilled gall stones: one liver mass and two abscesses. Dig Surg. 2006;23(3):198–200. https://doi.org/10.1159/000094739.

    Article  CAS  PubMed  Google Scholar 

  69. Ianniti DA, Zaydfudim VK, McKee J. Subphrenic and pleural abscess due to spilled gallstones. JSLS. 2006;10:101–4.

    Google Scholar 

  70. Hand AA, Self ML, Dunn E. Abdominal wall abscess formation two years after laparoscopic cholecystectomy. JSLS. 2006;10(1):105–7.

    PubMed  PubMed Central  Google Scholar 

  71. Viera FT, Armellini E, Rosa L, Ravetta V, Alessiani M, Dionigi P, Rossi S. Abdominal spilled stones: ultrasound findings. Abdom Imaging. 2006;31(5):564–7. https://doi.org/10.1007/s00261-005-0241-8.

    Article  PubMed  Google Scholar 

  72. AlSamkari R, Hassan M. Middle colic artery thrombosis as a result of retained intraperitoneal gallstone after laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2004;14(2):85–6. https://doi.org/10.1097/00129689-200404000-00007.

    Article  PubMed  Google Scholar 

  73. Koç E, Suher M, Oztuğut SU, Ensari C, Karakurt M, Ozlem N. Retroperitoneal abscess as a late complication following laparoscopic cholecystectomy. Med Sci Monit. 2004;10(6):CS27.

    PubMed  Google Scholar 

  74. Stevens S, Rivas H, Cacchione RN, O’Rourke NA, Allen JW. Jaundice due to extrabiliary gallstones. JSLS. 2003;7(3):277–9.

    PubMed  PubMed Central  Google Scholar 

  75. Aspelund G, Halldórsdóttir BA, Isaksson HJ, Möller PH. Gallstone in a hernia sac. Surg Endosc. 2003;17(4):657. https://doi.org/10.1007/s00464-002-4257-7.

    Article  CAS  PubMed  Google Scholar 

  76. Papasavas PK, Caushaj PF, Gagné DJ. Spilled gallstones after laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech A. 2002;12(5):383–6. https://doi.org/10.1089/109264202320884144.

    Article  PubMed  Google Scholar 

  77. Yadav RK, Yadav VS, Garg P, Yadav SP, Goel V. Gallstone expectoration following laparoscopic cholecystectomy. Indian J Chest Dis Allied Sci. 2002;44(2):133–5.

    PubMed  Google Scholar 

  78. Van Mierlo PJ, De Boer SY, Van Dissel JT, Arend SM. Recurrent staphylococcal bacteraemia and subhepatic abscess associated with gallstones spilled during laparoscopic cholecystectomy two years earlier. Neth J Med. 2002;60(4):177–80.

    PubMed  Google Scholar 

  79. Hawasli A, Schroder D, Rizzo J, Thusay M, Takach TJ, Thao U, Goncharova I. Remote complications of spilled gallstones during laparoscopic cholecystectomy: causes, prevention, and management. J Laparoendosc Adv Surg Tech A. 2002;12(2):123–8. https://doi.org/10.1089/10926420252939664.

    Article  PubMed  Google Scholar 

  80. Famulari C, Pirrone G, Macrì A, Crescenti F, Scuderi G, De Caridi G, Giuseppe AL. The vesical granuloma: rare and late complication of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2001;11(6):368–71. https://doi.org/10.1097/00129689-200112000-00006.

    Article  CAS  PubMed  Google Scholar 

  81. Werber YB, Wright CD. Massive hemoptysis from a lung abscess due to retained gallstones. Ann Thorac Surg. 2001;72(1):278–9.

    Article  CAS  PubMed  Google Scholar 

  82. Yao CC, Wong HH, Yang CC, Lin CS. Abdominal wall abscess secondary to spilled gallstones: late complication of laparoscopic cholecystectomy and preventive measures. J Laparoendosc Adv Surg Tech A. 2001;11(1):47–51. https://doi.org/10.1089/10926420150502959.

    Article  CAS  PubMed  Google Scholar 

  83. Battaglia DM, Fornasier VL, Mamazza J. Gallstone in abdominal wall–a complication of laparoscopic cholecystectomy. Surg Laparosc Endosc Percutan Tech. 2001;11(1):50–2.

    Article  CAS  PubMed  Google Scholar 

  84. Ok E, Sözüer E. Intra-abdominal gallstone spillage detected during umbilical trocar site hernia repair after laparoscopic cholecystectomy: report of a case. Surg Today. 2000;30(11):1046–8. https://doi.org/10.1007/s005950070032.

    Article  CAS  PubMed  Google Scholar 

  85. Bebawi M, Wassef S, Ramcharan A, Bapat K. Incarcerated indirect inguinal hernia: a complication of spilled gallstones. JSLS. 2000;4(3):267–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  86. Jacob H, Rubin KP, Cohen MC, Kahn IJ, Kan P. Gallstones in a retroperitoneal abscess: a late complication of perforation of the gallbladder. Dig Dis Sci. 1979;24:964–6. https://doi.org/10.1007/BF01311955.

    Article  CAS  PubMed  Google Scholar 

  87. Rothlin MA, et al. Stones spilled during cholecystectomy. A long-term liability for the patient. Surg Laparosc Endosc. 1997;7:432–4.

    Article  CAS  PubMed  Google Scholar 

  88. Tsui C, Klein R, Garabrant M. Minimal Invasive surgery: national trends in adoption and future directions for hospital strategy. Surg Endosc. 2013;27:2253–7.

    Article  PubMed  Google Scholar 

  89. Shea JA, Berlin JA, Bachwich DR, Staroscik RN, Malet PF, McGuckin M, et al. Indications and outcomes of cholecystectomy: a comparison of the pre and postlaparoscopic eras. Ann Surg. 1998;227:343–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  90. Khan MH, Howard TJ, Fogel EL, Sherman S, McHernyn L, Watkins JL, et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary center. Gastrointest Endosc. 2007;65:247–52.

    Article  PubMed  Google Scholar 

  91. Johanning JM, Gruenberg JC. The changing face of cholecystectomy. Am Surg. 1998;64:643–7 (PMID:9655275).

    CAS  PubMed  Google Scholar 

  92. Ingraham AM, Cohen ME, Ko CY, Hall BL. A current profile and assessment of north American cholecystectomy: results from the American college of surgeons national surgical quality improvement program. J Am Coll Surg. 2010;211:176–86.

    Article  PubMed  Google Scholar 

  93. Giger UF, Michel JM, Opitz I, Inderbitzin D, Kocher T, Krähenbühl L. Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS) study: Risk factors for perioperative complications in patients undergoing laparoscopic cholecystectomy: analysis of 22953 consecutive cases from Swiss Association of Laparoscopic and Thoracoscopic surgery databases. J Am Coll Surg. 2006;203:723–8.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None to declare

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Surgery, Royal Cornwall Hospitals NHS Trust, Treliske, Truro, TR1 3LJ, Cornwall, UK

    Paschalis Gavriilidis

  2. Department of General and Emergency Surgery, Bufalini Hospital, Cesena, Italy

    Fausto Catena

  3. Gastroenterology and Endoscopy Unit, University Hospital of Parma, University of Parma, Parma, Italy

    Gianluigi de’Angelis

  4. Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital (AP-HP), University Paris Cité, Clichy, France

    Nicola de’Angelis

Authors
  1. Paschalis Gavriilidis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fausto Catena
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gianluigi de’Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nicola de’Angelis
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

GP: conceptualization, formal analysis, investigation, methodology, software, validation, writing-original draft, editing, supervision; CF: formal analysis, investigation, methodology, validation, editing; GdA: formal analysis, investigation, methodology, validation, editing; NdA: conceptualization, formal analysis, investigation, methodology, software, validation, writing-original draft, editing, supervision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Gianluigi de’Angelis.

Ethics declarations

Ethical approval and consent to participate.

Not applicable.

Consent for publication

All the authors approved the present manuscript.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gavriilidis, P., Catena, F., de’Angelis, G. et al. Consequences of the spilled gallstones during laparoscopic cholecystectomy: a systematic review. World J Emerg Surg 17, 57 (2022). https://doi.org/10.1186/s13017-022-00456-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13017-022-00456-6

Keywords

World Journal of Emergency Surgery

ISSN: 1749-7922