Lost gallstones during laparoscopic cholecystectomy as a common but underestimated complication-case report and review of the literature.

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.

Malignant biliary obstruction: clinical and histopathologic correlation after treatment with self-expanding metal prostheses.

PURPOSE: To analyze clinical and autopsy findings in patients with malignant biliary obstruction treated with biliary endoprostheses. MATERIALS AND METHODS: Stents were inserted endoscopically in nine patients and transhepatically in 50. In 24 patients, autopsy was performed; in 22 cases, histologic analysis of the area in which the stent was placed was available. RESULTS: The technical success rate was 100%, and the clinical success rate was 92%. Complications occurred in 16 patients, with one procedure-related death. The rate of severe complications was 19%, primarily due to acute cholangitis (n = 9). Mean survival time was 175 days. Stent obstruction was found in 12 patients and occurred on average 196 days after stent placement. Secondary treatment was successful in all 12 patients. Only one of 24 autopsy specimens demonstrated macroscopic nonobstructive tumor ingrowth. Histologic analysis showed that the main reaction to the stent was connective tissue formation, which never occurred before 3 months. Invasion by tumor cells was noted in only five cases. CONCLUSION: Tumor ingrowth is not a major cause of stent obstruction.

[Treatment of venous stenoses and occlusions of benign etiology with vascular endoprostheses: a new, non-operative therapeutic concept]. / Behandlung von Venenstenosen und -verschlüssen benigner Atiologie mit vaskulären Endoprothesen: Ein neues, nichtoperatives Therapiekonzept.

8 patients (7 women and 1 man, age between 35 and 66 years, mean 46.3) suffering from a stenosis or occlusion of the pelvic or superficial femoral vein after surgical or percutaneous intervention were successfully treated with endovascular stents of the wallstent type. Clinical and Doppler sonographic as well as phlebographic controls showed patency of all stented lesions at followup times between 3 and 82 months (average 27 months). The use of percutaneous transluminal angioplasty (PTA) in the venous system in combination with implantation of self-expanding vascular endoprostheses offer a new therapeutic modality to treat veins with stenosis or occlusion of benign etiology without surgical intervention.