S. Johnston et al., THE NEED TO RETRIEVE THE DROPPED STONE DURING LAPAROSCOPIC CHOLECYSTECTOMY, The American journal of surgery, 167(6), 1994, pp. 608-610
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.