Perforation and Spillage of Gallstones During Laparoscopic Cholecystectomy: A Single-Center Study

Abstract

Background: Laparoscopic cholecystectomy has become the standard treatment for symptomatic gallstone disease due to its minimal invasiveness and faster recovery. However, intraoperative complications such as gallbladder perforation and gallstone spillage remain clinically significant, potentially leading to postoperative infections, bile leakage, and conversion to open surgery. Understanding their frequency and associated factors is critical for surgical safety and quality improvement. Objective: To determine the frequency and associated complications of gallbladder perforation and gallstone spillage during laparoscopic cholecystectomy in a tertiary care hospital. Methods: This single-center cross-sectional audit was conducted among 89 consecutive patients who underwent laparoscopic cholecystectomy at Shalamar Hospital, Lahore, between August and October 2021. Data were collected prospectively using a structured proforma, including demographic variables, diagnosis, operative findings, and postoperative outcomes. Statistical analyses were performed using SPSS version 27, applying Chi-square and Fisher’s exact tests with significance set at p<0.05. Results: The mean age of patients was 42.5±8.0 years, with females comprising 76.4% of the sample. Gallbladder perforation occurred in 21 patients (23.6%), while gallstone spillage was observed in 15 (16.9%). Perforation was more common in acute cholecystitis (35%) and correlated with longer operative duration (p=0.041) and higher conversion to open surgery (p<0.001). The most frequent complications were abdominal abscesses (6.7%), bile leakage (5.6%), and trocar-site infection (3.4%). Prolonged hospitalization was significantly associated with perforation (p=0.049). Conclusion: Gallbladder perforation and stone spillage remain common intraoperative events in laparoscopic cholecystectomy, particularly among patients with acute cholecystitis. Although most complications are minor, these findings highlight the importance of surgical expertise, meticulous dissection, and standardized intraoperative documentation to minimize morbidity.