Cases Of Gallstones Research Articles

Feasibility of transgastric endoscopic gallbladder-preserving surgery for benign gallbladder diseases (with video)

With the increasing realization of the importance of gallbladder function, choledochoscopic gallbladder-preserving surgery has been advocated for benign gallbladder diseases. However, limited information is available regarding the use of endoscopic gallbladder-preserving surgery (EGPS) for patients with benign gallbladder diseases. The aim of this study was to evaluate the feasibility of EGPS for benign gallbladder diseases. Between June 2020 and January 2021, 22 patients with gallbladder stones and/or gallbladder polyps were treated with EGPS. The main outcome measures included the rate of complications, residual gallbladder stones, and gallbladder stone recurrence. In this study, transgastric EGPS was successfully performed in 22 patients (13 female, 9 male) with benign gallbladder diseases, and included 8 cases of multiple gallstones, 4 cases of gallbladder polyps with gallstones, 6 cases of multiple gallbladder polyps, 2 cases of single gallstone, and 2 case of singe gallbladder polyp. The median time of transgastric EGPS was 118min. During hospitalization, 4 patients suffered localized peritonitis (4/22, 18.2%), and these patients successfully recovered after conservative medical treatment. None of the patients experienced massive bleeding, delayed bleeding, diffuse peritonitis, or any other serious complications. During the median follow-up of 4months, 1 patient suffered residual gallstone, while no gallstone recurrence or deaths related to transgastric EGPS occurred in any patients. Transgastric EGPS appears to be a feasible treatment method in selected patients with benign gallbladder diseases. However, as it is a new technique, further studies are needed to explore the long-term effectiveness of transgastric EGPS.

Genome-wide analysis identifies gallstone-susceptibility loci including genes regulating gastrointestinal motility.

Genome-wide association studies (GWAS) have identified several risk loci for gallstone disease. As with most polygenic traits, it is likely that many genetic determinants are undiscovered. The aim of this study was to identify genetic variants that represent new targets for gallstone research and treatment. We performed a GWAS of 28,627 gallstone cases and 348,373 controls in the UK Biobank, replicated findings in a Scottish cohort (1089 cases, 5228 controls), and conducted a GWA meta-analysis (43,639 cases, 506,798 controls) with the FinnGen cohort. We assessed pathway enrichment using gene-based then gene-set analysis and tissue expression of identified genes in Genotype-Tissue Expression project data. We constructed a polygenic risk score (PRS) and evaluated phenotypic traits associated with the score. Seventy-five risk loci were identified (p<5 ×10-8 ), of which 46 were new. Pathway enrichment revealed associations with lipid homeostasis, glucuronidation, phospholipid metabolism, and gastrointestinal motility. Anoctamin 1 (ANO1) and transmembrane Protein 147 (TMEM147), both in novel, replicated loci, are expressed in the gallbladder and gastrointestinal tract. Both regulate gastrointestinal motility. The gallstone risk allele rs7599-A leads to suppression of hepatic TMEM147 expression, suggesting that the protein protects against gallstone formation. The highest decile of the PRS demonstrated a 6-fold increased odds of gallstones compared with the lowest decile. The PRS was strongly associated with increased body mass index, serum liver enzymes, and C-reactive protein concentrations, and decreased lipoprotein cholesterol concentrations. This GWAS demonstrates the polygenic nature of gallstone risk and identifies 46 novel susceptibility loci. We implicate genes influencing gastrointestinal motility in the pathogenesis of gallstones.

S1469 A Case of Pleuro-Biliary Fistula Formation and Intrapulmonary Gallstones Due to Complication From Prior Cholecystectomy

S1469 A Case of Pleuro-Biliary Fistula Formation and Intrapulmonary Gallstones Due to Complication From Prior Cholecystectomy

Evaluation of the Bleeding Complications in Laparoscopic Cholecystectomy in a Tertiary Care Hospital: A Cross-Sectional Study

Objective: To determine the frequency of various sources of bleeding in laparoscopic cholecystectomy with special preference to gallbladder bed excluding port site.&#x0D; Methods: This cross-sectional study was consisted of 163 patients admitted through the outpatient department from Peoples Medical College Hospital Nawabshah. Ultrasound of abdomen was done as diagnostic modality and for assessment of gallstone disease. Finally the cases of gallstone were operated through laparoscopic cholecystectomy procedure and observed for sources of bleeding.&#x0D; Results: Out of 163 patients included in this study 138(84.7%) were female and 25(15.3%) patients were male; with female to male ratio of 5.52:1. The mean age was 41.85±7.83 years. Common sources of bleeding in laparoscopic cholecystectomy from liver bed side were 44(27%) cases followed by cystic artery in 17(10.4%) cases, hepatic artery and mesenteric vessel in 1(0.6%) case was observed.&#x0D; Conclusion: Bleeding during laparoscopic cholecystectomy are almost equally common and can prove to be lethal if not identified and managed during the operation. Good surgical technique, awareness and early recognition and management of such cases are keys to success when dealing with this problem.

A Study on the Performance Evaluation Criteria and Methods of Abdominal Ultrasound Devices Based on International Standards

The medical diagnostic ultrasound market has grown steadily in recent years, thanks to the increasing popularity of minimally invasive surgery among patients and active investments in the medical ultrasound market. In addition, the diagnostic ultrasound market is expected to continue to grow in the global market, given the importance of ultrasound and ongoing technological developments. In the case of the gallbladder, cases of gallstones and nonalcoholic fatty liver disease, all of which can be diagnosed with abdominal ultrasound, the number of domestic patients continues to increase every year. The safety of abdominal ultrasound has also been improved due to the national health insurance expanding its coverage to include gallstones and diseases such as those of the liver and gallbladder. However, no standards by which the performance of abdominal ultrasound can be evaluated have been explicitly established. Therefore, we aimed to assess the performance of abdominal ultrasound using criteria such as sound output level, operating frequency accuracy, resolution, maximum display depth, distance accuracy, time accuracy, and blood flow velocity accuracy. These criteria were derived by investigating the principles of ultrasound and the characteristics and structure of transducers, as well as by analyzing the specifications of abdominal ultrasound set by the International Electrotechnical Commission (IEC) 60601-2-37.

Analysis of related factors for gallstones related gallbladder intraepithelial neoplasia and establishment of prediction models

Objective: To evaluate the related factors of gallstones related gallbladder intraepithelial neoplasia(GBIN) and establish the prediction models for gallstones related GBIN. Methods: The clinicopathological data of 750 patients who underwent cholecystectomy for gallstones at Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to December 2018 and the postoperative pathological examination showed chronic cholecystitis or GBIN were analyzed retrospectively,including 150 cases of gallstones with GBIN and 600 cases of gallstones with chronic cholecystitis.There were 264 males and 486 females with age of (51.3±14.5) years (range: 18 to 90 years).The related factors for gallstones related GBIN were screened by χ2 test and Logistic regression model,and the prediction models were established based on independent related factors and internal validation was conducted.The original data were randomly divided into a training cohort(526 cases) and a validation cohort(224 cases) at a ratio of 7∶3,and the nomogram and tree augmented naïve Bayes were conducted to establish the prediction model for gallstones related GBIN.The consistency index(C-index),calibration chart,area under the receiver operating characteristic curve(AUC) and confusion matrix were used to evaluate the prediction performance of the two models. Results: Univariate analysis showed that age,gallstones history(years),gallbladder size,whether the gallbladder mucosa smooth or not,whether the gallbladder wall thickened or not,gallstones diameter,and number of gallstones were related factors for the occurrence of gallstones related GBIN (χ²=19.957,8.599,9.724,9.301,8.341,15.288,9.169,all P<0.05).Multivariate analysis showed that age (OR=2.23,95%CI:1.50-3.31,P<0.01),gallbladder size (OR=2.11,95%CI:1.17-3.80,P=0.013),whether the gallbladder mucosa smooth or not (OR=1.80,95%CI=1.13-2.88,P=0.014),gallstones diameter(OR=2.98,95%CI:1.71-5.21,P<0.01),and number of gallstones (OR=2.14,95%CI=1.34-3.42,P<0.01) were independent related factors for the occurrence of gallstones related GBIN; the C-index of the nomogram in training cohort and validation cohort were 0.708 and 0.696,respectively.The AUC of the two models in training cohort were 70.60% and 70.73%,and in validation cohort were 68.14% and 67.47%,respectively.The accuracy of the two models in training cohort were 69.96% and 70.72%,and in validation cohort were 66.96% and 67.41%,respectively. Conclusion: Age,gallbladder size,whether the gallbladder mucosa smooth or not,gallstones diameter and number of gallstones are independent related factors for the occurrence of gallstones related GBIN,and the nomogram and tree augmented naïve Bayes prediction models based on the above factors can be used to predict the occurrence of GBIN.

The Role of Gallstones in Gallbladder Cancer in India: A Mendelian Randomization Study.

Past history of gallstones is associated with increased risk of gallbladder cancer in observational studies. We conducted complementary observational and Mendelian randomization (MR) analyses to determine whether history of gallstones is causally related to development of gallbladder cancer in an Indian population. To investigate associations between history of gallstones and gallbladder cancer, we used questionnaire and imaging data from a gallbladder cancer case-control study conducted at Tata Memorial Hospital, Mumbai, Maharashtra, India (cases = 1,170; controls = 2,525). We then used 26 genetic variants identified in a genome-wide association study of 27,174 gallstone cases and 736,838 controls of European ancestry in an MR approach to assess causality. The association of these genetic variants with both gallstones and gallbladder cancer was examined in the gallbladder cancer case-control study. Various complementary MR approaches were used to evaluate the robustness of our results in the presence of pleiotropy and heterogeneity, and to consider the suitability of the selected SNPs as genetic instruments for gallstones in an Indian population. We found a strong observational association between gallstones and gallbladder cancer using self-reported history of gallstones [OR = 4.5; 95% confidence interval (CI) = 3.5-5.8] and with objective measures of gallstone presence using imaging techniques (OR = 2.0; 95% CI = 1.5-2.7). We found consistent causal estimates across all MR techniques, with ORs for gallbladder cancer in the range of 1.3-1.6. Our findings indicate a causal relationship between history of gallstones and increased risk of gallbladder cancer, albeit of a smaller magnitude than those found in observational analysis. Our findings emphasize the importance of gallstone treatment for preventing gallbladder cancer in high-risk individuals.

A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Age, Gender, Geographic and Clinical Differences for Gallstone and Its Subtypes in China: A Nationwide Study Among Approximately 11 Million Adults

Background:There is no comprehensive nationwide study on the prevalence of gallstone and its risk factors in China. Methods:We used the data set from preventive health screening centers covering all provinces in mainland China except for Tibet, and a total of 10,937,993 adults were included, who received abdominal ultrasonography from January 1st to December 31st, 2017. Gallstone was categorized into gallbladder (GB) stones, intrahepatic bile duct (IHD) stones, and extrahepatic bile duct (EHD) stones. The prevalence of gallstone and its different subtypes, as well as their risk factors were investigated. Findings:The nationwide age-standardized and gender-standardized prevalence (ASGS-prevalence) of gallstone diseases in 2017 was 5.13% (95% CI: 5.11%-5.14%). GB stones accounted for 76.3% of all gallstone cases, followed by IHD (24.3%) and EHD (0.2%). The age standardized prevalence was higher in women than that in men (5.41% vs 4.85%, p 1). Interpretation:The gallstone disease was highly prevalent in China. The prevalence largely varied by disease subtype, demographic factors, geographic location and metabolic factors. Public health strategies preventing gallstones should be region-specific and target on the distinct risk factors of different gallstone subtypes. Funding Statement: This research was funded by International Science and Technology Cooperation Projects (2016YFE0107100 and 2015DFA30650), CAMS Clinical and Translational Medicine Research Funds (2019XK320006), CAMS Innovation Fund for Medical Science (CIFMS) (2017-I2M-4-003 and 2018-I2M-3-001), Capital Special Research Project for Health Development (2014-2-4012), Beijing Natural Science Foundation (L172055 and 7192158), the Fundamental Research Funds for the Central Universities (3332018032), the National Undergraduates Innovation and Training Program of Peking Union Medical College (2019zlgc0652), and National Ten-thousand Talent Program. Declaration of Interests: There is no conflict of interest to declare. Ethics Approval Statement: This study was reviewed and approved by the Institutional Review Board of Peking University (PU IRB).

S3488 The Break-Up: Parting Ways With Impacted Intrahepatic Stones by Electrohydraulic Lithotripsy

INTRODUCTION: Intrahepatic gallstones are rare, and can be difficult to access. Impacted or large (≥15mm) stones pose a greater challenge and typically cannot be eradicated with conventional endoscopic techniques. We present a case of left-sided intrahepatic gallstones, treated with cholangioscopy-guided electrohydraulic lithotripsy (EHL). CASE DESCRIPTION/METHODS: A 79-year old White Female with a history of atrial fibrillation on systemic anticoagulation, and GERD presented after two episodes of bright red blood in her stool. She reported four days of weakness, fatigue, and nausea. Vital signs were normal, and physical exam was only remarkable for irregular cardiac rhythm. Complete blood count and comprehensive metabolic panel were unremarkable. CT abdomen showed no bleeding source but revealed new left intrahepatic ductal dilatation. A small hypodense lesion, measuring 0.5 cm was also present anterior to the gallbladder. EGD was normal, and colonoscopy revealed an 18mm sigmoid tubulo-villous adenoma presumed to be the likely bleeding source. MRCP revealed left-sided intrahepatic biliary ductal dilatation and mild extrahepatic biliary duct dilatation without choledocholithiasis or pancreatic ductal dilatation. The patient was referred for EUS with ERCP to rule out cholangiocarcinoma. EUS showed a 9 mm × 7 mm lesion in the left intrahepatic duct, not amenable to FNA. ERCP was then performed, with SpyGlass-guided direct visualization of the biliary tree. Multiple impacted stones were found in the left intrahepatic ducts, measuring up to 20mm (see Figures 1, 2 and 3). EHL was implemented with successful clearance of multiple large stone fragments. Two plastic stents were placed; one in the left hepatic duct to maintain patency, and the other in the ventral pancreatic duct to decrease risk of post ERCP pancreatitis. DISCUSSION: Conventional percutaneous procedures for treating patients with recurrent hepatolithiasis often involve multiple dilation sessions before stone extraction. EHL is superior to conventional management with a high efficacy in clearing hepatolithiasis, and a post-procedure clearance rate up to 91%. The complication rate of EHL is 7-9% with most common complications of pancreatitis, cholangitis, sepsis, and hemobilia. Fortunately, our patient did not experience any complications, and she is scheduled for follow-up ERCP with stent removal in 2-3 months. This case demonstrates EHL via peroral endoscopic cholangioscopy as a highly successful and safe technique for treating hepatolithiasis.Figure 1.: Left intrahepatic stone.Figure 2.: Left intrahepatic stone (2).Figure 3.: EHL therapy of Left intrahepatic stone.

Gallstones in Egyptian infants and children: risk factors, complications and outcome: a single center experience

BackgroundThe widespread use of abdominal ultrasonography in children documented increased detection rate of gallstones. The aim of this study was to assess the possible risk factors of gallstones and to detect the complication rate and outcome of the disease in Egyptian infants and children from a hepatologist perspective. This prospective study included 35 cases, with ultrasound-detected gallstones, who presented to the Pediatric Hepatology Unit from July 2015 to October 2017. All patients were initially evaluated by full history, general and abdominal examination, laboratory assessment, and ultrasound findings to detect possible risk factors of gallstones. Management approach was individualized for each patient according to his/her condition, and the patients were followed up at 3 months interval.ResultsThe patients’ ages ranged from 3.5 months up to 17 years. The median age of gallstone detection was 2 years. Gallstones were symptomatic in 62.9% with abdominal pain in 51.4%. Complications in the form of choledocholithiasis were detected in 7 patients (20%). Laparoscopic cholecystectomy was done for 7 patients while conservative management was applied for 24 patients. Complete resolution occurred in 8.3% and partial resolution in 33.3%. Chronic hemolytic anemia was the most commonly identified risk factor for gallstones. Patients needed surgical intervention had significant higher serum cholesterol and LDL levels (P = 0.006 and P = 0.002 respectively).ConclusionRisk factors for gallstones could be identified in most of pediatric cases. Symptomatic presentation is common among the pediatric population. Conservative management is recommended for asymptomatic cases of gallstones in children. Laparoscopic cholecystectomy is a safe and recommended procedure for complicated and symptomatic cases of gallstones.

Gallstones at chronic spontaneous urticaria patients: A retrospective clinical study.

Chronic spontaneous urticaria (CSU) is a chronic, inflammatory skin disease can be triggered by many factors such as inflammatory process. To assess accompanying gallstone in CSU patients and to evaluate laboratory test results. We retrospectivelyscanned the files of the 108 patients with CSU who had been diagnosed CSU in September 2017-September 2019. Accompanied gallstone cases by detecting transabdominal ultrasound (TUS) or were 11 patients. Nine patients had also had cholecystectomy history. We seperated these 20 patients as Group A than the rest. WBC count is 9.38 ± 2.37 in Group A and 8.03 ± 2.04 in Group B. Platelet count was also differ between two groups significantly (Group A = 328.70 ± 85.62 × 103 /mm3 vs. Group B = 287.12 ± 72.77 × 103 /mm3 ). Neutrophil count was more in Group A (5.87 ± 1.65) than Group B (4.76 ± 1.75). Gallstone history of family was significantly higher in Group A (n = 12 positive/8 negative) than Group B. These findings were significant statistically p < .05. CSU can be associated with inflammation and gallstones. It is needed to perform further investigations to detect these relations and pathways.

Žučni kamenci i pravo vreme operacije - čekati ili intervenisati?

Introduction: Gallstones are the most common cause of biliary pancreatitis. After the alleviation of the acute phase of pancreatitis, the surgery follows in the majority of cases (cholecystectomy). Objective: To present when is the right time for surgical intervention in gallstone cases after pancreatitis as a complication. Case report: An 85-year-old patient presents with abdominal pain. He is afebrile, eupnoeic, pale, BP 140/80 mmHg, with diffuse abdominal tenderness to palpitation. Native abdomen X-ray shows hydroaeric levels. The patient was referred to a surgeon and operated on urgently. Cholecystectomy was not performed. Due to cardiovascular disease and problems with blood vessels, the patent had had two cardiosurgical interventions in the past. Three months after cardiosurgical intervention the patient presents with jaundice at his CiP office. Physical examination confirms the yellow color of skin and mucosae. The patient is afebrile, without abdominal tenderness. Serological blood tests were negative for hepatitis B, C, and HIV. Abdominal ultrasonography showed a stone in the gallbladder and it was consistent with greater risk of recidivant biliary pancreatitis. The patient was operated and the total cholecystectomy was performed. Conclusion: Patients with gallstones are at higher risk for acute pancreatitis. In patients with gallstones and consecutive biliary pancreatitis as a complication, cholecystectomy should be performed during the first hospitalization.

A study on treatment modalities adopted for gallstone disease at a Tertiary care hospital

The first Cholecystostomy is credited to John Stough Bobbs in Indianapolis on June 15, 1867. His patient a 32 year old woman had a large abdominal mass which proved to be the gall bladder filled with clear serous fluid and gallstones. He opened the gallbladder, removed the stones and closed it by sutures. His patient survived until the age of 77, when she died of atherosclerosis. This study has been based on the analysis of 25 cases of gallstones admitted to Hospital. After admission a detailed history was taken and clinical examination carried out. Various investigations were done to assess the patient. All 25 cases were subjected to laparotomy and all of them were evaluated before surgery with Ultrasonography. All patients had cholecystectomy as the main procedure. The decision regarding exploration of CBD was made on the basis of clinical, investigation and operative criteria. Among the two cases (8%) with wound infection one patient was diabetic who was treated conservatively. Temporary biliary leak from drain site stopped after 10 days. The patient with postoperative jaundice was investigated and found to have CBD stone, which was removed by ERCP, subsequently jaundice disappeared, and the patient with post cholecystectomy syndrome had dyspepsia, right hypochondriac tenderness.

Alcohol Consumption Can Reduce the Risk of Gallstone Disease: A Systematic Review with a Dose-Response Meta-Analysis of Case-Control and Cohort Studies.

Background/AimsGallstone disease (GSD) is a common gastrointestinal disorder. Clinical epidemiological studies revealed that alcohol consumption has a preventive effect on the development of GSD. This study aimed to evaluate the relative risks of drinking for GSD development and investigate the dose-response relationships.MethodsA systematic search of the MEDLINE, EMBASE, and Cochrane Library databases for studies published up to 2018 was performed. All studies that satisfied the following eligibility criteria were included: patients with GSD with or without cholecystitis; and cohort or case-control studies investigating the association between alcohol consumption and GSD development.ResultsSixteen case-control studies including 24,401 gallstone cases and 76,185 controls, and eight cohort studies with 14,693 GSD cases among 2,432,471 person-years were enrolled. Alcohol consumption presented a decreased overall risk of GSD (pooled relative ratio [RR], 0.84; 95% confidence interval [CI], 0.79 to 0.89; p=0.02). Subgroup analyses according to drinking levels indicated a gradual risk reduction for GSD compared to nondrinkers (light: RR, 0.96; 95% CI, 0.94 to 0.99; p=0.75; moderate: RR, 0.80; 95% CI, 0.75 to 0.85; p=0.27; high: RR, 0.66; 95% CI, 0.56 to 0.79; p<0.01). A nonlinear risk reduction was observed in a dose-response meta-analysis of all the studies (n=14, p<0.01 for nonlinearity).ConclusionsIn this systematic review with meta-analysis, alcohol consumption could decrease the risk of GSD, and the dose-response analysis revealed a dose-dependent linear risk reduction and a weakened linear trend between alcohol consumption levels less than and greater than 28 g/day.

Pattern of gall stone (GS) size & number in 1263 otherwise normal Sudanese subjects & their impact in the development of gall bladder disease & complications at the National Centre of Gastroentrology & Hepatology in Sudan during the last 10 years

1263 cases of GS, examined by ultrasound to decide size & number of stones. Size of stones was categorized into sand, tiny(1-4 mm), small(4-1.0 cm), medium(11-20 mm), big(21-30 mm), large(>30 mm), mixed stones(variable sizes). Number of stones categorized into; single, 2 stones, 3 stones, few( 20) & packed(no GB free space). Females scored (74.4%) GS cases. Prevalence of GS significantly increased above the age of 30years. Single stone was the predominant stone (21.2%) followed by multiple (19.6%), least was packed stones(3.1%), number didn't increase significantly with age while size significantly increased with age. Commonest stone size in both sexes was small stone in (32.1%) of cases. Predominance of fine, big & variable GS in females in 81.6%, 85% & 83.7% in total cases respectively. GS with normal gall bladder constituted (55.3%), Acute cholycystitis, had the highest prevalence of (28%) among gall bladder disease, chronic cholycystitis (16.7%). Gall bladder disease had no correlation with stone size & number. Risk of Gall bladder obstruction was significantly increased with single gall stone. Total complications of pericholycystic fluid, empyema, perforation, gangrene, emphysema, pancreatitis, Mirrizi, fistula & mucocoele occured in (9.8%) of cases. The predominant complication was pancreatitis (36.3%) of total complications one third of which had additional pseudopancreatic cyst. Pancreatitis was exclusively related to stone size Conclusion: No correlation of GS size & number to sex, single gall stone was the most prevalent stone number & carried a higher risk of gall bladder obstruction & higher incidence of acute cholycystitis. Acute cholycystitis was the commonest gall bladder disease. Pancreatitis was the most prevalent complication related to Stones

BILE DUCT INJURIES

Objective: To find out frequency of bile duct injuries during cholecystectomyprocedures either open or laparoscopic. Study design: Prospective observational study. Placeand duration of study: This study was conducted at Surgical department, Liaquat UniversityHospital Jamshoro and Dow International Hospital Karachi, from July 2012 to December2013. Methodology: This study consisted of hundred patients. Patients were divided in twogroups. Group A for open cholecystectomy (OC) comprising of 50 patients who underwentelective open cholecystectomy. Group B for Laparoscopic cholecystectomy (LC) comprisingof 50 patients who underwent elective Laparoscopic cholecystectomy. Inclusion criteria wereall patients diagnosed case of gallstones on the basis of ultrasound abdomen, any age andboth gender. Exclusion criteria included not willing for surgery, General anesthesia problem,pregnant ladies due to risk of foetal loss, carcinoma of gall bladder, stone in CBD and obstructivejaundice. Results: Out of 100 cases of gallstone were operated for either laparoscopic / opencholecystectmy. In open cholecystectomy group 20(40 % ) were male and 30(60 %) female.Ratio male: female ratio of 1:1.5. In laparoscopic cholecystectomy group 11(22 % ) were maleand 39(78 %) female with male: female ratio of 1:3.5. There was wide variation of age rangingfrom a minimum of 10 year to 70 year in both group. The mean age was 41.28+12.30 yearsfor OC group and 38.44+13.50 years for LC group (p 0.02). Common bile duct injury wereoccurred 2(4%) patients in laparoscopic cholecystectomy group while 3(6%) patients observedin open cholecystectomy group. Conclusions: We conclude that found bile duct injury 2(4%)patients in laparoscopic cholecystectomy group while 3(6%) patients observed in opencholecystectomy group

Laparoscopic cholecystectomy difficulties, challenges and surprises

Introduction: Laparoscopic cholecystectomy is considered since long time as gold standard treatment for cholecystolithiasis. Preoperatively surgeon can anticipate difficulty of the procedure and prepare a plan how to deal with it. Sometimes the surgeon can be faced with a surprise intra-operatively. Methods: We collected retrospectively a series of cases subjected to laparoscopic cholecystectomy in Alexandria university from 2014 to 2017, in which there were technical or anatomical difficulties, intra-operative surprises, and how was the procedure completed safely. From 350 cases of laparoscopic cholecystectomy, 23 cases considered difficult or with intra-operative challenge. we had one case of acute cholecystitis in a child with situs invertus totalis, one case of left sided gall bladder, one case of gall stones after left donor hepatectomy, one case of heamangioma adherent to the gall bladder, one case diagnosed a huge liver cyst, one case child 4 years with acute cholecystitis and pancreatitis, five cases with previous big abdominal surgeries, one case with multiple whitish spots all over the liver, one case of accessory bile duct, three cases of caterpiller hump, two cases of stump cholecystectomy, and 4 cases of laparoscopic cholecystectomy after failed open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a frequently performed surgery with expected difficulties and challenges to the surgeons.

Study of complications of laparoscopic cholecystectomy

Laparoscopic cholecystectomy has become the standard operative procedure for treating cholelithiasis. The incidence of laparoscopic complications is 1.1% to 5.2% in minor procedures and 2.5% to 6% in major ones. We retrospectively analyzed the data of 1112 patients underwent laparoscopic cholecystectomy during the period between January 2002 and January 2014 in Departments of Surgery in Aden General Hospital, Saber and Alwaly private hospitals in Aden city. Of the 1112 patients in whom laparoscopic cholecystectomy was attempted, 62 (5.6%) required conversion to open cholecystectomy. The most common intraoperative complications are adhesions (8.9%) and inflammation (6%). Postoperative complications were developed in 137 patients (12.3%). There are many cases of symptomatic gallstones with anatomic or pathologic considerations that prevent the laparoscopic cholecystectomy, and need to convert to laparotomy.

Clinical and biological study of the 31 cases of gallstones

This study reports the clinical and biological signs, as well as the morphological aspect and the chemical composition of the calculus during the biliary stones. The study population consisted of 31 patients with an average age of 49 years (30 women and one man) with biliary lithiasis and who had cholecystectomy. Hepatic colic and epigastralgia were the most evocative clinical signs. The calculus were pigmentary (n=6), cholesterolicand mostly single (n=18), and mixed (n=6) and one infectious multiple lithiasis. Cholesterol was found in 22 calculi (70.96%). We have found a significant increase in liver enzymes and total bilirubin, which is more pronounced in pigmentary lithiasis. Our results showed that most gallstones were composed of cholesterol. These results indicate the influence of diet and chronic hemolysis in calculus formation. More investigation should allow knowing the nutritional and environmental factors influencing gallstones formation in Tunisia, in order to prevent this disease.