RESUMEN
Introduction: Laparoscopic cholecystectomy (LC) represents one of the most commonly performed routine abdominal surgeries. Nevertheless, besides bile duct injury, problems caused by lost gallstones represent a heavily underestimated and underreported possible late complication after LC. Methods: Case report of a Clavien-Dindo IVb complication after supposedly straightforward LC and review of all published case reports on complications from lost gallstones from 2000-2022. Case Report: An 86-year-old patient developed a perihepatic abscess due to lost gallstones 6 months after LC. The patient had to undergo open surgery to successfully drain the abscess. Reactive pleural effusion needed additional drainage. Postoperative ICU stay was 13 days. The patient was finally discharged after 33 days on a geriatric remobilization ward and died 12 months later due to acute cardiac decompensation. Conclusion: Intraabdominal abscess formation due to spilled gallstones may present years after LC as a late complication. Surgical management in order to completely evacuate the abscess and remove all spilled gallstones may be required, which could be associated with high morbidity and mortality, especially in elderly patients. Regarding the overt underreporting of gallstone spillage in case of postoperative gallstone-related complications, focus need be put on precise reporting of even apparently innocuous complications during LC.
RESUMEN
OBJECTIVE: This study evaluated amounts of debris, smear layer, and recrystallized dentin on root canal walls treated with an Nd:YAG laser. The presence of carbonized material was also assessed. METHOD AND MATERIALS: The root canals of 36 extracted incisors were prepared by stepdown and stepback techniques and divided into 4 groups. One group was not treated further, while 3 others were exposed to the laser beam at an energy density of 159, 239, or 318 J/cm2. The roots were split longitudinally, photographed, and examined using a scanning electron microscope. The amounts of debris, smear layer, and recrystallized dentin were recorded from horizontal bands around the root, 2, 6, and 10 mm from the apices. RESULTS: Mean smear layer scores were similar for all groups at the 3 levels examined, ranging from 2.157 to 2.851 on a scale of 0.0 to 3.0. Mean debris scores were similar for all groups at the 3 levels examined, ranging from 0.774 to 1.408 on a scale of 0.0 to 3.0. Recrystallized dentin was recorded in all 3 irradiated groups at the 2-mm level, but only in the group irradiated with 318 J/cm2 at the 6- and 10-mm levels. Severe carbonization was recorded at the 2-mm level. CONCLUSION: Use of the Nd:YAG laser did not reduce the mean amounts of debris and smear layer compared to a nonirradiated group. Carbonization was recorded in the apical part of the canal, but this is not obvious when only scanning electron photomicrographs are examined.
