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REASONS AND ADMINISTRATIVE WAYS OF GALLSTONE SPILLING IN PERITONEAL CAVITY DURING LAPAROSCOPIC CHOLECYSTECTOMY

Ba Mingchen,Chen Xunru,Chen Jisheng,et al. Department of Hepatobiliary Surgery,Sun Yat Memorial Hospital Sun Yatsen University of Medical Science.Guangzhou 510120  
Objective To investigate the reasons and administrative ways of spilling gallstone in peritoneal cavity during laparoscopic cholecycstectomy(LC).Methods Between September 1991 and December 1999,7200 patients with gallstone spillage into peritoneal cavity during LC were retrospectively analysed in our unit,and the successfull experiences were summed up for preventon.Results In this group,there were 363 patients with gallstone spillage during LC,and the incidence of gallstone spillage was about 5%.In these patients,219 cases were because of cutting into the wall of the gallbladder when it is being dissected away from the liver.43cases were because of dislodgement of the clip from the gallbladder side of the cystic duct,and other 67 cases were because of applying excessive force on the gallbladder during extraction through too narrow abdominal orifice,other 67 cases were because of gallbladder perforation puncture by forceps during enlarging abdominal orifice.But the true incidence of retained stones during LC is diffcult to determine in this group.Following up 1~8 years ,there were not complications secondary to these spilled stones such as peritoneal abscess,stone migration through retroperitoneum to a previous surgical wound or mechanical small obstruction.Conclusion Gallbladder perforation by puncture during dissection,forceful retration on the gallbladder during dissection resulting in tearing the gallbladder,dislodgement of the clip from the gallbladder side of the cystic duct and applying excessive force on the gall bladder during extraction through anterior abdominal orifice are the main reason of spillage gallstones during LC.In order to avoid some complication related to spilled stones during LC,various effort should be made to remove them.However,it is not recommended to perform laparotomy in order to remove all spillage gallstones during LC because most retained stones are harmless to patients.
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