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Outcome of laparoscopic cholecystectomy-spillage of gall stones: A prospective study

Rajneesh Kumar, Ritu Kataria, Sahil Singh Bangar, Ankita Attri, Harsimran Singh, Arshdeep Jassal.

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Background: Laparoscopic Cholecystectomy is the most common abdominal procedure performed for Cholelithiasis. Various advances have been made in the laparoscopic cholecystectomy procedures, yet its side effects still prevail. Most common being spillage of gallbladder contents in the peritoneal cavity during laparoscopic cholecystectomy.
Objectives: To compare adverse outcomes post laparoscopic cholecystectomy in patients where spillage had occurred and in patients where it did not occur.
Methods: This Prospective study was conducted in 600 patients who underwent Laparoscopic Cholecystectomy at Punjab Institute of Medical Sciences ( PIMS), Jalandhar, Punjab, India. Patients were divided into two groups of 300 patients each. Group A (Spillage) where spillage of bile and stones occurred and Group B (Non spillage) where no spillage has occurred. Patients were in age group of 18 to 74 years. Exclusion of patients who were immunocompromised, patients on immunosuppressive therapy, patients with pre-operative fever, Diabetes mellitus and Choledocholithiasis and those converted to open cholecystectomy. We compared age, sex, adhesions, duration of surgery, duration of post-operative hospital stay, post-operative fever, leukocytosis, post-operative abdominal pain, port site infection, intra-abdominal abscess or chronic sinus or fistula formation. Follow up of patients was done up to 10 months.
Results: Results were significant in both groups considering age, sex, adhesions, duration of surgery, duration of hospital stay, post- operative fever, leukocytosis, port site infection and post-operative abdominal pain.
Conclusion: Complications as a result of gallbladder contents spillage into peritoneal cavity do occur infrequently. Every effort should be made to retrieve them. Immediate Laparotomy is not indicated. It is important that we remain vigilant about such a possibility of gallstone spillage during surgery.

Key words: laparoscopic cholecystectomy, spillage, gallstones

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