Complications Due to Spilled Gallstones and Surgical Clips During Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis. The rate of general complications related to laparoscopic cholecystectomy is lower than in conventional or open cholecystectomy, although injury to the bile duct and intra-abdominal infection caused by gallstones left in the peritoneal cavity are more frequent in laparoscopic cholecystectomy.1-3 Accidental opening of the gallbladder is a relatively frequent intraoperative incident (15%-40%).1,4-6 Despite the fact that gallbladder perforation facilitates bile leakage, the spilling of gallstones into the peritoneal cavity only occurs in 16%-66% of perforation cases.1,4,7 Perforation of the gallbladder with gallstone spillage extends operating time4 and may lead to some of them being left in the peritoneal cavity. Nevertheless, despite the increased rate of perforations with gallstone spillage, complications caused by intraperitoneal gallstones are infrequent, though sometimes they may be serious.4-8 On the other hand, the metallic clips used in laparoscopic cholecystectomy may also be left in the abdominal cavity and cause complications.9,10 The purpose of this study is to review the different complications related to ectopic material (gallstones or clips) in the peritoneum, their incidence, risk factors, and management. For this purpose, a review of the existing literature has been performed based on a search of the MEDLINE database using different combinations of the following key words: “Laparoscopic cholecystectomy, gallbladder perforation, spilled gallstones, lost gallstones, surgical clips, complications, abdominal abscess, adhesions.” No language restriction has been applied to the search.We found 207 articles on gallbladder perforation and/or complications related to intra-abdominal gallstones.Another 18 studies were experimental and dealt with the influence of gallstones in the peritoneum. No experimental studies Review article