From the Guidelines
The incidence of patients who develop gallstones years after cholecystectomy is approximately 0.08 to 0.3% due to spilled gallstones during laparoscopic cholecystectomy, with severe morbidity complications requiring mostly major surgical procedures 1.
Incidence and Risk Factors
The incidence rate of perforation of the gallbladder during laparoscopic cholecystectomy ranges from 6 to 40%, with a spillage rate of gallstones secondary to perforation reported as 16% 1.
- The incidence rate of complications of spilled gallstones may range from 0.04 to 19% 1.
- Predicting factors for developing severe complications include acute cases, older age, male sex, number of spilled stones more than 15 with diameter > 1.5 cm, pigment stones, and perihepatic localization 1.
Management and Outcomes
- Symptomatic patients with lost gallstones present with severe morbidity complications and require mostly major surgical procedures, with 87% of patients needing surgical intervention and 12% needing US ± CT scan guidance drainage 1.
- Only one perioperative death was reported in a systematic review of 85 patients with spilled gallstones during laparoscopic cholecystectomy 1.
Clinical Implications
- Standardization of the management of spilled gallstones is needed urgently, with hospitals reviewing their policy and clinical guidelines 1.
- Patients with a history of gallstones before surgery may have a higher risk of developing new stones, and regular follow-up with liver function tests may be beneficial for high-risk patients 1.
From the Research
Incidence of Gallstones after Cholecystectomy
- The incidence of gallstones after cholecystectomy is a significant problem, with studies suggesting that it can occur in a small percentage of patients 2, 3.
- A study published in 2013 found that 2.3% of patients developed retained common bile duct stones after cholecystectomy, with smaller gallstone size being a significant risk factor 2.
- Another study published in 2013 found that 1.9% of patients experienced gallstone recurrence after cholecystectomy, with the ABCG8-D19H genotype being a significant predictor of recurrence 3.
Risk Factors for Gallstone Recurrence
- Small gallstone size has been identified as a risk factor for retained common bile duct stones after cholecystectomy 2.
- The ABCG8-D19H genotype has been found to be associated with gallstone recurrence after cholecystectomy 3.
- Bile duct disease and multiple diagnoses during index admission have also been found to be associated with a higher recurrence rate 4.
Management of Gallstone Disease
- Cholecystectomy is the most commonly performed operation for gallstone disease, but it is not without risks and complications 5, 6.
- Endoscopic retrograde cholangiopancreatography (ERCP) is a common treatment modality for common bile duct stones, but it has its own set of risks and complications 6.
- Conservative management of gallstone disease in the elderly population has been found to have a high recurrence rate, with over a third of patients experiencing recurrence within 2 years 4.