LAPAROSCOPIC CHOLECYSTECTOMY

FATE OF SPILLED BILE WITH GALLSTONES DURING LAPROSCOPIC CHOLECYSTECTOMY

Abstract

There is a continued debate on fate of spilled bile with gallstones during laparoscopic cholecystectomy, so we felt that the outcome needs further evaluation in detail. Although laparoscopic cholecystectomy become increasingly popular, but it is associated with a slightly higher chances of injury to biliary tree and perforation of gallbladder with spillage of bile only or with gallstones. Objectives: (1) To evaluate fate of spilled bile with gallstones during laparoscopic cholecystectomy. (2) To assess various possible outcomes. (3) Suggestions to prevent these and their management. Design of study: Prospective study. Setting: Surgical unit of Muhammad Medical College Hospital, Mirpurkhas. Period: February 2008 to April 2011. Data source: Total 100 patients who underwent elective laparoscopic cholecystectomy were included. Age, sex, duration of operation, operative findings, duration of hospital stay and post-op complications were recorded in proforma and analyzed on SSP version 10. Material and method: The patients who underwent cholecystectomy, and had intra-operative spillage were shortlisted, included in this study and followed up. Short-term follow-up was based on OPD visits for 2 to 3 weeks postoperatively, and long-term follow-up was achieved by regular OPD visits or telephone conversation in patients at a mean of 1.4 years (range 2 to 39 months).all minor or major complications were recorded in preformed proforma. Results: A total of 100 patients underwent laparoscopic cholecystectomy. Among the patients who underwent elective laparoscopic cholecystectomy the incidence of Iatrogenic perforation of the gallbladder is around 40%, of whom about 22% had spillage of only bile and 18% in whom spillage of both bile and gallstones. Conclusions: It is concluded that laparoscopic cholecystectomy with gall bladder perforation along and spillage of bile and stones took longer operative time than intact gall bladder. We suggest that attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure. In our study, we revealed that no harm is caused by retained gallstones during laparoscopic cholecystectomy after long term followup by evaluation.