UNUSUAL ABSCESS PATTERNS FOLLOWING DROPPED GALLSTONES DURING LAPAROSCOPIC CHOLECYSTECTOMY

BACKGROUND: Laparoscopic cholecystectomy has become the standard treat ment for symptomatic cholelithiasis, Numerous clinical trials have dee med it a safe procedure, regardless of the known increased risk of bil e duct injury. However, the consequences and incidence of less well-kn own complications are still being addressed. METHODS: Between 1993 and 1995, 1,130 laparoscopic cholecystectomies were performed at two majo r metropolitan medical centers. Of these patients, we know of 3 (0.3%) who subsequently developed abscesses as a consequence of dropped ston es during the laparoscopic cholecystectomy, One additional patient who underwent prior laparoscopic cholecystectomy at another institution d eveloped rate infection as well. RESULTS: All 4 patients developed lat e purulent abscesses that ultimately required open surgical drainage, and 1 patient developed trocar site ''tumor'' masses that were seconda ry to inflammatory tissue around gallstone fragments. All patients wer e successfully treated by surgical drainage, stone removal, and antibi otics. Trocar site inflammatory masses required excision only. Signifi cant costs were involved in the diagnosis, management, and duration of therapy for these problems. CONCLUSION: This experience closely resem bles that of other centers and points out the existence of a late post operative complication following laparoscopic cholecystectomy that was rarefy encountered with open cholecystectomy. Strategies for avoiding this problem are discussed. Whether dropped stones are an indication for conversion to open cholecystectomy remains unclear. Thorough irrig ation at time of laparoscopic cholecystectomy with or;without placemen t of a drain in the subhepatic space does not prevent this complicatio n. (C) 1998 by Excerpta Medica, Inc.