IS THERE ANY CONTRIBUTIVE ROLE OF GALLSTONES ON INTRAPERITONEAL ADHESION FORMATION?

Abstract

Gallstones spillage into the peritoneal cavity may occur during the performance of laparoscopic cholecystectomy. In order to investigate the pathological conseguences of this phenomena, an experimental study was designed on 80 Sprague-Dawley rats at Istanbul University Experimental Study Center (DETAM). The animals were divided into 8 groups (n= 10). 2ml. of physiologic saline (PS), sterile bile (SB), and infected bile (İB) were injected into the peritoneal cavity of the groups 1 ,2, and 3 respectively. A 3 to 4 mm. median abdominal incision was made on the rats in groups 4 to 8. A single sterile gallstone was located on the right upper quadrant of the animals in group 4, 5 and 6. After the abdominal cavity was closed, 2ml. of PS, SB, and IB of each group respectively were injected into the peritoneal cavity. In group 7 and 8, sterile pincett were introduced to the right upper quadrant of the animals without any manipulation and incisions were closed right after that. Then, 2ml. of PS was injected into the abdominal cavity of group 7. At the end of the 8th week, all the animals were sacrificed, and their peritoneal cavities were inspected from different incisions to note and score any adhesion formation. No pathological change was observed in groups 1 ,2, 3, 7 and 8. However, adhesions were observed in 8 (80%), 9 (90%) and 8 (80%) rats of groups 4, 5, and 6, respectively. When the groups were compared, the results were statistically significant (p<0.005). As a result, this study supports the idea that gallstone spillage into the abdominal cavity is associated with an increased risk of intraabdominal adhesion formation and that every attempt could be made to extract these stones which are spilled during laparoscopic cholecystectomy.