THE NEED TO RETRIEVE THE DROPPED STONE DURING LAPAROSCOPIC CHOLECYSTECTOMY

The effect of bile and gallstones on the peritoneal cavity was evaluat ed in an experimental animal study. Ninety male Sprague-Dawley rats we re randomly allocated to one of six groups (n = 15). Groups 1 to 3 rec eived an intraperitoneal injection (2 mt) of saline, sterile bile, and infected bile, respectively. Groups 4 to 6 underwent a lower midline abdominal incision (3 to 5 mm). In groups 4 and 5, a single gallstone (< 3 mm diameter) was placed in the right upper quadrant and, after cl osure of the wound, the animals were injected with sterile bile and in fected bile, respectively. Group 6 animals under-went laparotomy alone , followed by injection of sterile saline (2 nun). Ah animals were kil led at 4 weeks and the peritoneal cavity was carefully examined. No in tra-abdominal lesions were noted in groups 1 to 3. Adhesions were note d in 11 (73%) and 10 (61%) animals of groups 4 and 5, respectively. Tw o intra-abdominal abscesses were noted in group 4 animals. No intra-ab dominal lesions were noted in any group 6 animals. This study suggests that bile in combination with gallstones in the peritoneal cavity is associated with an increased risk of intra-abdominal adhesion formatio n and possible abscess formation, and that every attempt should be mad e to retrieve stones lost during cholecystectomy.