The fate of the dropped gallstones during laparoscopic cholecystectomy

Stones can be spilled from the gallbladder during laparoscopic cholecystect omy. These stones can be left in the peritoneal cavity or trapped at the tr ocar site. The potential late sequel and associated morbidity are not well documented. We reviewed the records of four patients who underwent laparosc opic cholecystectomy at Mount Sinai Medical Center in New York City who suf fered from late complications attributed to gallstones left in the peritone al cavity or abdominal wall. Four patients presented 1-14 months after lapa roscopic cholecystectomy with intraabdominal and abdominal wall abscesses. The spillage of gallstones was noticed during the initial operation only in one of the patients. Three patients required laparotomy and open drainage of intraabdominal abscesses with drainage of pus and gallstones after faile d attempts at percutaneous drainage. Two patients underwent local explorati on of an abdominal wall abscess containing stones. Stones left in the abdom inal cavity or trapped in trocar sites after laparoscopic cholecystectomy c an cause serious late complications requiring repeated surgical interventio ns. Every effort should be made in order to avoid spillage of stones during dissection of the gallbladder and cystic duct and during retrieval of the gallbladder through the abdominal wall.