surgical ppt

1. Wednesday,
April 12, 2023
1
Complications of lost gall
stones after LC
DR. HIWA OMER AHMED
PROFESSOR IN GENERAL AND BARIATRIC SURGERY
UNIVERSITY OF SULAIMANI
COLLEGE OF MEDICINE – SULAIMANI CITY-
KURDISTAN

2. Wednesday,
April 12, 2023
2
The event
 During laparoscopic cholecystectomy (LC), the
gallbladder is perforated during its detachment from
the liver or during its extraction through the trocar site
in up to 40% of cases, especially if the indication for
LC is acute cholecystitis.


3. Wednesday,
April 12, 2023
3
Incidence
 In 30% of LCs, gallstones are dropped into the
peritoneal cavity around the liver, on the omentum,
between small bowel loops or into the abdominal wall.
 In 20% of LCs dropped gallstones are not removed
because of their
1. Number
2. Fragmentation
3. Location

4. Wednesday,
April 12, 2023
4
Complications
A. Adhesions
B. inflammatory reactions
C. abscesses or peritonitis, especially if they are
1. large
2. pigmented
3. numerous, fragmented, infected
4. associated with infected bile
Surgical series have shown that complications related
to lost gallstones occur in 0.5–6% of LC

5. Wednesday,
April 12, 2023
5
D. Migration
1. Migration through the anterior or posterior abdominal wall or the
diaphragm and into the urinary tract or bronchus.
2. The resulting abscess can obstruct the digestive tract or drain
into the digestive tract to cause a communicating abscess.
3. It can also drain through the abdominal wall and the digestive
tract to cause an enterocutaneous fistula.
4. The stone can migrate into the intestine and cause gallstone
ileus.

6. Wednesday,
April 12, 2023
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Sequelae and time of presentations

7. Wednesday,
April 12, 2023
7
Radioopaque stone

8. Wednesday,
April 12, 2023
8
Cellulites

9. Wednesday,
April 12, 2023
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abscess

10. Wednesday,
April 12, 2023
10
Fistula