72302 - Don’t cry over spilled gallstones. Consequences of gallstones left in the abdominal cavity, a matched cohort study

Introduction In 2.4% of laparoscopic cholecystectomies, gallstones are left in the abdomen after surgery. Studies on the long-term effect of spilled gallstone are scarce, but complications such as abscesses are described in 7% of these cases. Are the rest of these patients symptom free? This study aimed to examine if gallstones left in the abdominal cavity increase the risk of surgical site infection (SSI), post-operative abscess and chronic abdominal pain. Method The study is based on GallRiks, the Swedish register of gallstone-surgery, and a retrospective review of patient records for patients undergoing laparoscopic cholecystectomy at Södersjukhuset in Stockholm 2008 – 2022. Patients with registered retained gallstones in the abdominal cavity were identified and matched with a control group without an intraoperatively perforated gallbladder based on age, gender, surgery indication, operation year and surgical approach. Preoperative, intraoperative, and postoperative variables were collected. The cases and controls were compared with chi-square test and data was analyzed using Cox regression with stone spillage as exposure, adjusted for ASA-classification and antibiotic treatment. Result 76 cases with retained gallstones were matched with 152 cases without gallbladder perforation. No significant associations between retained gallstones and abdominal pain, nor abscess development, were found. There was however a significant association between retained gallstones and SSI with a hazard ratio of 6.18 [1.63 - 23.4]. There was no significant effect of antibiotics on the risk for any of the outcomes. Discussion Few patients seem to develop complications from retained gallstones, so maybe some gallstones left in the abdomen at the end of surgery is acceptable?