Spilt bile and gallstones effect during laparoscopic cholecystectomy: an experimental study for adhesion formation

Laparoscopic cholecystectomy (LC) is recognized as the standard treatment for symptomatic gallstone disease. In comparison with open techniques, LC results in a higher rate of iatrogenic biliary tract damage and spillage of bile and stones. The present study was designed to compare intraperitoneal adhesion formation following LC due to the bile and stone spillage. In this randomized experimental study, 15 dogs were randomly allocated to three groups. Each group contained five dogs. The control group underwent LC, while in the group of bile and stone spillage (BS), 5 cc of a mixture of dog bile and a sterile ground human gallstone was placed in the bed of the gallbladder following LC. The bile spillage (B) group underwent LC, followed by adding 5 cc of the bile in the bed of the gallbladder. Postsurgical adhesion formation was measured, using Nair and Zühlke classifications for inflammation, fibrosis, and neovascularization. Adhesion formation was noted in one dog from the control and B groups, whereas all animals in group 2 were found to develop high-grade adhesion. Bile cultures were negative for the control group and group B with adhesion. Based on the findings, bile spillage, as well as gallbladder stone spillage, is related to a significant increase in adhesion formation after LC. Therefore, it is necessary to avoid the bile and stone spillage.