Intended for healthcare professionals

Rapid response to:

Endgames Case Review

Abdominal pain after surgery

BMJ 2017; 357 doi: (Published 06 April 2017) Cite this as: BMJ 2017;357:j1481

Rapid Response:

Re: Abdominal pain after surgery and complications of lparoscopic cholecystectomy

For the sake of completeness the catalogue of complications after laparoscopic cholecystectomy(1) ought to highlight those complications which are more common after the laparoscopic procedure than after the open procedure. These include common bile duct injury(2) and gallstone spillage(3). The authors of a literature review published in the year 2002 noted that, since the year 1963, 127 case reports had been published documenting complications secondary to spilled gallstones following the laparoscopic procedure, as opposed to only 2 case reports following the open procedure(3). The discrepancy was attributable to the fact that spilled gallstones are much easier to retrieve during the open procedure than during the laparoscopic procedure, with the consequence that many surgeons simply leave the spilled gallstones behind(4) . However, approximately 5% of patients with spilled and eventually retained gallstones become symptomatic(5) due to a wide range of complications(6).
These include local infections such as subhepatic abscess, retrohepatic abscess, and intra abdominal abscess, and also pelvic abscess. Mechanical complications include intestinal obstruction and lodgment in distal hernia sacs. Migration to other systems may also occur giving rise to empyaema and cholelithoptysis, and also giving rise to urinary tract excretion and haematuria(6).. Late complications include intra abdominal abscess 8 years after laparoscopic cholecystectomy(7), and recurrent haemoptysis 5 years after the procedure(8)..
(1) Sheik Z., Ahmad M., Pallan A
Abdominal pain after surgery
BMJ 2017;357:1461
(2) Johnson A
Laoaroscopic surgery
Lancet 1997;349:631-635
(3) Papasavas P., Caushaj PF., Gagne DJ
Spilled gallstones after laparoscopic cholecystectomy
Journal of laparoendoscopic & advanced surgical techniques 2002;12: 383-386
(4) Arishi A., Rabie E., Khan SH et al
Spilled gallstones: the source of an enigma
Journal of the Society of laparoendoscopic surgeons 2008;12:321-325
(5) Horton M., Florence MG
Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy
Am J Surg 1998;175:375-379
(6) Sathesh-Kumar T., Saklani AP., Vinayagam R., Blackett RL
Spilled gallstones during laparoscopic cholecystectomy: a review of the literature
Postgrad Med J 2004;80:77-79
(7) Dodradin A., Jugmohan S., Dabul L
Gallstone-related abdominal abscess 8 years after laparoscopic cholecystectomy
Journal of the society of laparoscopic surgeons 2013;:17:139-142
(8) Fontaine JP., Issa RA., Yantiss RK., Podbielski FJ
Intrathoracic gallstones: a case report and literature review
Journal of the society of laparoendoscopic surgeons 2006;10:375-378

Competing interests: No competing interests

07 April 2017
oscar,m jolobe
retired geriatrician
manchestr medical association
simon building, brunswick street manchestr M13 9PL