Thoracic complications from retained abdominal gallstones after laparoscopic cholecystectomy: is it always mandatory a thoracic approach? [Ulus Travma Acil Cerrahi Derg]
Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-07280 | DOI: 10.14744/tjtes.2020.07280  

Thoracic complications from retained abdominal gallstones after laparoscopic cholecystectomy: is it always mandatory a thoracic approach?

Gennaro Perrone1, Mario Giuffrida2, Antonio Tarasconi1, Elena Bonati2, Fausto Catena1
1Department of Emergency and Trauma Surgery, Parma University Hospital
2Department of Surgery, Parma University Hospital

Introduction: Thoracic complications from retained abdominal gallstones are quite rare, the incidence rate ranges between 0.08% and 0.3%. Diagnosis and treatment of these complications are challenging due to the uncommon presentations and the debated role of the thoracic approach. This review of all cases reported in literature aims to discuss the best practice of this rare condition.
Method: A comprehensive literature search was carried-out for articles from January 1993 to May 2019 using pubmed, medline, embase, sciencedirect. The following mesh-words was used: “cholelithopthysis”, “thoracic”, “gallstones” “retained”, “spilled”. All cases of thoracic complications from retained gallstones after laparoscopic cholecystectomy were extrapolated.
Results: Twenty-four patients were included. Most common symptoms were fever, hemoptysis and lithoptysis. Symptoms after laparoscopic cholecystectomy presented after a mean time of 9.8±14.2 months (range from 1 week to 60 months). A delayed diagnosis was found in fourteen patients (58.4.%). Only four subjects were treated successfully with antibiotic therapy alone (16.7%) whereas 20 patients needed surgery or interventional radiology (83.3%). Seven patients (29.2%) were successfully managed with an abdominal approach. Three patients were managed with thoracentesis, thoracoscopic- thoracotomic drainage (12.5%). Right lung decortication and pulmonary wedge resections were necessary in ten patients (41.6%).
Discussion: Clinicians always have to inquire about previous cholecystectomy for cholelithiasis related diseases in all patients suffering for recurrent right-sided pleural / lung affections, to improve diagnostic delay. Escalated approach has to be performed: empirical antimicrobial therapy followed by targeted therapy as soon as microbiological data are available; afterwards abdominal surgery is effective in about 30% of patients while the remaining patients have to be submitted to a thoracic approach.

Keywords: Cholelithoptysys, laparoscopic cholecystectomy, thoracic complications, abdominal complications, retained gallstones, spilled

Corresponding Author: Elena Bonati, Italy

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