Long-Term Consequences of Intraoperative Spillage of Bile and Gallstones during Laparoscopic Cholecystectomy

David C. Rice, Muhammed A. Memon, Richard L. Jamison, Tischa Agnessi, Duane Ilstrup, Michael B. Bannon, Michael B. Farnell, Clive S. Grant, Michael G. Sarr, Geoffrey B. Thompson, Jonathan A. Van Heerden, Scott P. Zietlow, John H. Donohue

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94 Scopus citations


Laparoscopic cholecystectomy is associated with a higher incidence of iatrogenic perforation of the gallbladder than open cholecystectomy. The long-term consequences of spilled bile and gallstones are unknown. Data were collected prospectively from 1059 consecutive patients undergoing laparoscopic cholecystectomy over a 3-year period. Details of the operative procedures and postoperative course of patients in whom gallbladder perforation occurred were reviewed. Long-term follow-up (range 24 to 59 months) was available for 92% of patients. Intraoperative perforation of the gallbladder occurred in 306 patients (29%); it was more common in men and was associated with increasing age, body weight, and the presence of omental adhesions (each P < 0.001). There was no increased risk in patients with acute cholecystitis (P = 0.13). Postoperatively pyrexia was more common in patients with spillage of gallbladder contents (18% vs. 9%; P < 0.001). Of the patients with long-term follow-up, intra-abdominal abscess developed in 1 (0.6%) of 177 with spillage of only bile, and in 3 (2.9%) of 103 patients with spillage of both bile and gallstones, whereas no intra-abdominal abscesses occurred in the 697 patients in whom the gallbladder was removed intact (P < 0.001). Intraperitoneal spillage of gallbladder contents during laparoscopic cholecystectomy is associated with an increased risk of intra-abdominal abscess. Attempts should be made to irrigate the operative field to evacuate spilled bile and to retrieve all gallstones spilled during the operative procedure.

Original languageEnglish (US)
Pages (from-to)85-91
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number1
StatePublished - 1997

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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