HPB SO79 - Dropped Gallstones After Laparoscopic Cholecystectomy: An Umbrella Review

Abstract Background The enduring presence of gallstones after laparoscopic cholecystectomy (LC) presents a substantial clinical obstacle, potentially resulting in morbidity and diagnostic intricacies, frequently leading to delayed identification. This umbrella systematic review aims to investigate the available body of literature regarding the symptoms, signs, etiology, management strategies, and associated complications of retained gallstones. Method We performed an extensive search of the academic literature spanning several databases, namely PubMed, Embase, Scopus, Web of Science, and Google Scholar. Inclusion criteria for this research encompassed systematic reviews, with or without meta-analysis, focusing on the examination of spilled gallstones in terms of signs, symptoms, diagnosis, imaging, and management. The assessment of potential bias in the final study selection was undertaken utilizing the R-AMSTAR and Risk of Bias in Systematic Reviews (ROBIS) assessment tools. Results The most sites for lost gallstones were the subhepatic, perihepatic, retroperitoneal, right flank and pelvic regions. A higher proportion of patients underwent emergency laparoscopic cholecystectomy compared to those who underwent elective procedures. complications included intra-abdominal abscesses, foreign body granulomas, parietal wall abscesses or pelvic abscesses. Multiple stones more common than single stones. Various clinical presentations have been documented, including the presence of abdominal masses simulating malignancy, intestinal obstruction, pelvic pain or fistula formation. Surgical intervention emerged as the primary treatment approach. Computed tomography was the most frequently employed diagnostic modality for stone identification (70.2%), ultrasonography (US) (63.2%) and X-ray (42.9%). Conclusion Our study highlights the overlooked issue of spilled gallstones post-laparoscopic cholecystectomy, posing diagnostic challenges and potential complications. Surgeons and patient education regarding this is lacking, stressing the need for increased awareness. Comprehensive studies with larger cohorts are essential for understanding risk factors and developing effective interventions.