INTRAPERITONEAL CHOLELITHIASIS AFTER LAPAROSCOPIC CHOLECYSTECTOMY - BEHAVIOR OF LOST CONCREMENTS AND THEIR ROLE IN ABSCESS FORMATION

In two experimental studies we sought preliminary information about th e behavior of concrements lost in the peritoneal cavity during laparos copic cholecystectomy, Materials and Methods: In study 1, human gallst ones were analyzed using X-ray diffraction, calssified in three groups and examined with an ultramicroscope; then they were implanted in the peritoneal cavity of rats, After 8 weeks or 6 months, the animals wer e sacrificed and the concrements analyzed again as before, The tissues surrouding the calculi were also examined histologically, In study 2, human gallstones were examined with regard to bacterial contamination on the surface or in the middle of the calculi, The cholesterol conte nt was analyzed, and the stones were divided into three groups and imp lantated in the rats as in the first study, After 8 weeks, the animals were sacrificed and areas with identifiable tissue reactions were exa mined histologically and microbiologically, Results: The concrements l ost their crystalline formation without any relation to their former c holesterol content, as shown by X-ray diffraction as well as ultramicr oscopy. Mineralogically, these changes are a certain sign of structura l dissolution. Cholesterol stones only caused abscess formations in as sociation with gram-negative bowel germs, Sterile pigment concrements often led to a mesenchymal reaction such as granulomas. Contaminated p igment stones also resulted in extensive abscess formations.