The outcome of incidental lost gallstones after laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the preferred surgical technique for symptomatic cholelithiasis. The advantage over traditional cholecystectomy is mainly due to mild post-operational course – specific for minimally invasive procedures and good cosmetic effect. One of the most common complications is gallbladder perforation and bile spillage, together with gallstones. Gallbladder rupture mainly occurs during its dissection (75%) and removal from the abdominal cavity through the umbilical port. As a result accidental loss of gallstones in the peritoneal space or abdominal wall is possible. The presence of a contaminated gallstone may result in the formation of an abscess and/or fistula. Complications occur many months or years after the performed procedure and further surgical intervention may be necessary. We report a case of a 58-year-old female patient admitted due to symptomatic umbilical hernia. The patient underwent laparoscopic cholecystectomy two years earlier, followed by purulent exudation in the umbilical region, and consequently hernia occurred. The patient was qualified for surgery. During hernia repair we additionally noticed in the left mid-gastric region the presence of an abscess 10 cm in diameter, connected via the fistula canal with the umbilical region. A gallstone, lost during cholecystectomy, was found inside the fistula canal. Lost gallstones after laparoscopic cholecystectomy may lead to serious complications and suspicion of leaving unretrieved gallstones should be recorded in the operative notes.