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1.  Complications of spilled gallstones following laparoscopic cholecystectomy: a case report and literature overview 
Introduction
Gallbladder perforation is common and occurs in 6 to 40% of laparoscopic cholecystectomy procedures. In up to a third of these cases, stones are not retrieved and complications can arise many years post-operatively. Diagnosis can be difficult and patients may present to many specialties within medicine and surgery. We seek to present our case and review the literature on prevention and management of "lost" stones.
Case presentation
Our patient is a 77-year-old woman who presented to the urology clinic with a loin abscess that developed five years after laparoscopic cholecystectomy. Radiological studies showed retained abdominal gallstones and an associated abscess formation. These were drained under ultrasound guidance on several occasions and the patient now suffers from chronic sinusitis. Due to her age and comorbidities, she has declined definitive surgical intervention to remove the stones.
Conclusion
Gallbladder perforation during laparoscopic cholecystectomy is a reasonably common problem and may result in spilled and lost gallstones. Though uncommon, these stones may lead to early or late complications, which can be a diagnostic challenge and cause significant morbidity to the patient. Clear documentation and patient awareness of lost gallstones is of utmost importance, as this may enable prompt recognition and treatment of any complications.
doi:10.4076/1752-1947-3-8626
PMCID: PMC2737763  PMID: 19830235
2.  Patient Experience With Gallstone Disease in a National Health Service District Hospital 
Background:
The prevalence of gallstone disease in the community makes it an important area of service in district general hospitals. Laparoscopic surgical techniques in synergy with modern imaging and endoscopic and interventional techniques have revolutionized the treatment of gallstone disease, making it possible to provide prompt and definitive care to patients.
Methods:
Patients with gallstone disease were treated based on a predetermined protocol by a special-interest team depending on the patient's mode of presentation. Data were collected and analyzed prospectively.
Results:
Our team treated 1332 patients with gallstone disease between September 1999 and December 2007. Patients (249) with acute symptoms presented through Accident and Emergency (A&E). Despite varied presentations, laparoscopic treatment was possible in all but 8 patients. The study comprised 696 patients who underwent laparoscopic cholecystectomy (LC) as in-hospital (23 hour) cases in a stand-alone center, and 257 outpatients and 379 inpatients. Sixty-seven patients with acute cholecystitis had their surgery within 96 hours of acute presentation. Seventy patients had laparoscopic subtotal cholecystectomy. The overall morbidity was 2.33% with 3 patients having residual common bile duct stones; 3 patients had biliary leak from cystic or accessory duct stumps and one had idiopathic right segmental liver atrophy; 19 had wound infections, 5 had port-site hernia. No mortalities occurred during the 30-day follow-up.
Conclusion:
We believe that prompt investigation with imaging and endoscopic intervention if needed along with LC at the earliest safe opportunity by a specialized dedicated team represents an effective method for treating gallstone disease in district general hospitals. Our experience with over 1000 patients has offered us the courage of conviction to say that justice is finally here for gallstone sufferers.
PMCID: PMC3016000  PMID: 19275855
Gallstones; Cholecystectomy; Laparoscopic
3.  An apricot story: view through a keyhole 
Background
Very few cases of small bowel obstruction due to ingested fruits have been described in literature, and most of these have managed by a laparotomy. Laparoscopic assisted surgery can effectively deal with such impacted foreign bodies, thereby avoiding a formal laparotomy.
Case presentation
A 75 years old lady was admitted via the Accident and Emergency to the surgical ward with a three-day history of abdominal pain and vomiting. Investigations were suggestive of acute small bowel obstruction. On laparoscopy, there was an area of sudden change in calibre of small bowel with dilated proximal and collapsed distal segment in distal jejunum. A foreign body, dried undigested apricot, was extracted by mini-laparotomy.
Discussion
Small bowel obstruction is a frequent cause of emergency surgery, and aetiology may include food bolus obstruction. Diagnosis is usually confirmed intra-operatively. Foreign body impacted in small bowel can be removed by open or laparoscopic methods.
Conclusion
Generally, laparotomy is performed for diagnosis and management in acute bowel obstruction, but with increasing expertise, laparoscopy can be equally effective with all the other advantages of minimal access approach.
doi:10.1186/1749-7922-2-20
PMCID: PMC1976312  PMID: 17697369

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