THE FATE OF INTRAPERITONEALLY RETAINED GALLSTONES WITH DIFFERENT MORPHOLOGIC AND MICROBIOLOGIC CHARACTERISTICS - AN EXPERIMENTAL-STUDY

Management of intraperitoneally retained gallstones after laparoscopic cholecystectomy (LC) is controversial, as their natural course is not known. This study was undertaken to assess the probable effects of st one morphology and clinically obvious infection on the outcome of reta ined gallstones in a mouse model. Forty albino mice were divided into four groups. Group I served as the control group (simple laparotomy, n = 10). Groups II, III, and IV (n = 10 in each group) were study group s. ''Intact-sterile-cholesterol'' (group n), ''crushed-sterile-cholest erol'' (group III), and ''intact'' (n = 5) [group IVa] and ''crushed'' (n = 5) [group IVb] ''infected-cholesterol'' gallstones aseptically r etrieved from three different human patients were implanted to the per itoneal cavity of the animals. Group IV animals were implanted with st ones retrieved from an acutely inflamed gallbladder with proven infect ion. Animals were sacrificed 6 and 12 weeks after the operations. Cult ures and tissue samples were obtained. No animal was lost, no microsco pic or macroscopic abnormality was observed in groups I and II, and cu ltures remained negative. In group III, adhesions surrounding the frag mented stones were evident at the 12th week, and no mortality was enco untered. The histopathology revealed a fibroblastic reaction, and cult ures remained negative in group III. In group IV, three animals from g roup IVb and one animal from group IVa died because of intra-abdominal sepsis before their sacrifice. All remaining mice showed severe adhes ions with localized abscesses at the 12th week. In conclusion, intrape ritoneally retained cholesterol gallstones remain inert and do not cau se serious peritoneal reaction unless they are crushed into fragments or are from an acutely inflamed gallbladder. It is for this group of p atients that laparotomy for total stone clearance is probably not just ifiable. Better stone retrieval techniques or even laparotomy may be w orthwhile considering in patients with crushed and particularly infect ed retained stones.