INTRAABDOMINAL CONTAMINATION AFTER GALLBLADDER PERFORATION DURING LAPAROSCOPIC CHOLECYSTECTOMY AND ITS COMPLICATIONS

Background: Gallbladder perforation often occurs during laporoscopic c holecystectomy. Methods: The frequency and causes of gallbladder perfo ration as well as the relevant clinical background factors were invest igated in 110 patients undergoing laparoscopic cholecystectomy. We als o evaluated intraperitoneal contamination by bacteria and gallstones a t the time of gallbladder perforation and investigated whether perfora tion caused early or late postoperative complications. Results: Intrao perative gallbladder perforation occurred in 29 of the 110 patients (2 6.3%). It was caused by injury with an electric knife during dissectio n of the gallbladder bed, injury during gallbladder retraction with gr asping forceps, injury during gallbladder extraction from the abdomen, and slippage of cystic duct clips (potentially causing bile and stone spillage). Perforation was more frequent in patients with positive bi le cultures and in those with pigment stones (p < 0.02), but not in pa tients with cholecystitis or cystic duct obstruction. The peritoneal c avity was contaminated by bacteria in 11/29 patients (37.9%) and by sp illed stones in 3/29 patients (10.3%). There was no difference in the incidence of postoperative complications between the patients with and without perforation either in the early postoperative period or durin g follow-up for 24-42 months. Only one patient developed abdominal pai n and fever in the early postoperative period, and they were probably related to perforation. Conclusions: Although gallbladder perforation is sometimes unavoidable during laparoscopic cholecystectomy, the risk of severe complications appears to be minimized by early closure of p erforation, retrieval of as many of the spilled stones as possible, an d intraperitoneal lavage.