Cholecystectomy For Gallstones Research Articles

Hereditary spherocytosis: review of cases and discussion of hematologic characteristics and updated diagnostic testing

Hereditary spherocytosis is a common inherited type of hemolytic anemia that results from abnormal morphology of erythrocytes. It has a high occurrence in North Americans and northern Europeans with a prevalence of 1/2000. There is a wide range in age and symptoms at presentation with some individuals being asymptomatic and others having severe diseases requiring blood transfusions. Based on the severity of symptoms, management may vary from simple observation to frequent blood transfusions, cholecystectomy for gallstones, and splenectomy. Timely diagnosis may be critical to minimize complications. Diagnostic tests have been available with varying degrees of accuracy. However new diagnostic tests with greater specificity and sensitivity are now available for more accurate diagnosis of Hereditary Spherocytosis in individuals of all ages including newborns. Illustrative cases are presented that show the variability in presentation, symptoms, complications, and care. Information is presented updating diagnostic testing that allows earlier diagnosis of children with hereditary spherocytosis. Additionally, the hematologic findings suspicious and consistent for this diagnosis are presented, serving as a guide when testing should be initiated.

COMPARISON OF CANCER OR DYSPLASIA FREQUENCY BY AGE GROUPS IN PATIENTS WHO HAD CHOLECYSTECTOMY

Gallbladder carcinomas are the most common malignancy of the biliary tract. Since it does not have specific signs and symptoms, it is mostly detected during cholecystectomy for gallstones. In this direction, we also found dysplasia in 74 of the 530 patients included in our study, and gallbladder carcinoma in 3 patients, in order to show the frequency of dysplasia and carcinoma in patients who underwent cholecystectomy due to benign gallbladder diseases. This is very important in catching gallbladder cancers at an early stage and increasing the success of treatment. For this reason, it is necessary to carefully follow the pathology analysis reports after the operation, even for benign reasons.

Risk Factors for Gallstones and Cholecystectomy: A Large-Scale Population-Based Prospective Cohort Study in Japan

Introduction: Studies investigating the risk of gallstones in the Japanese population are sparse. To our knowledge, this is the first prospective cohort study assessing risk factors of gallstones in Japan. Methods: A nationwide population-based prospective cohort of 112,109 men and women, aged 40–69 years, self-completed questionnaires at baseline regarding exposures to potential risk factors, between 1990 and 1994. The occurrence of gallstones and cholecystectomy for gallstones were ascertained from another questionnaire after 10 years. Odds ratios and the 95% confidence intervals were calculated using the multivariate logistic regression. Results: During the 10-year follow-up, 3,092 (5.0%) participants developed gallstones and 729 (1.2%) participants required cholecystectomy. Increasing age, high body mass index, and diabetes mellitus were associated with the risk of gallstones in both sexes. In men, weight gain or loss of >5 kg over the follow-up period and stress were associated with risk of gallstones, whereas alcohol intake was inversely associated with the risk. In women, weight gain of >5 kg during the follow-up period, smoking, menopause, and lipid-lowering drugs were associated with risk of gallstones, whereas late onset of menarche was inversely associated with risk of gallstones. The risk of cholecystectomy broadly reflected the risk of gallstones for both sexes respectively. Conclusion: Risk factors for both gallstones and cholecystectomy for gallstones are multifactorial and differ between men and women. Novel findings in this study include an inverse association between late onset of menarche and gallstones, and an association between self-reported stress in men and gallstones.

Clinical Effect and Effective Rate of Laparoscopic Cholecystectomy for Gallstones Complicated with Gallbladder Polyps

This paperA total of 62 patients with gallstones and gallbladder polyps were selected from May 2019 to May 2020, who were divided into the observation group (n=31, laparoscopic cholecystectomy) and the control group (n=31, open cholecystectomy) in a 1:1 ratio. The clinical indicators, clinical efficacy, level of pain and complication rate of the two groups were recorded and compared. Results Indicators such as the operation duration (38.64±14.42min), blood loss (30.42±8.21ml), length of stay (4.71±1.82 d), first anal exhaust (21.82±6.65min), drainage volume (72.02±4.21ml), length of incision and the time for the recovery of gastrointestinal functions in the observation group were better than the control group (P<0.05). The clinical efficacy of the observation group (96.77%) was higher than that of the control group (80.65%), with statistical value =4.0260 (P<0.05). The level of pain of the observation group was lower than that of control group (P<0.05), while the complication rate in the observation group (3.22%) was also lower than that of the control group (22.58%) (P<0.05). Laparoscopic cholecystectomy is an effective treatment of gallstones complicated with gallbladder polyps, which can alleviate pain and improve the prognosis, and is thus worthy of promotion.

The Risk of Venous Thromboembolism in Patients with Gallstones.

The objective of this study is to assess the relationship between gallstones and venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and the risk of VTE after cholecystectomy for gallstones. This nationwide population-based cohort study retrieved the hospitalization database from the Longitudinal Health Insurance Research Database (LHID2000), a database belonging to the National Health Insurance (NHI) program of Taiwan. A total of 345,793 patients aged ≥ 18 years with gallstones diagnosed between 2000 and 2010 were identified as the study cohort. The beneficiaries without gallstones were randomly selected as the control cohort by propensity score matching with the study cohort at a 1:1 ratio based on age, sex, urbanization, occupation, comorbidities, and year of the index date. We compared the risk of VTE between both cohorts and measured the risk differences of VTE between the gallstones patients with (n = 194,187) and without cholecystectomy (n = 151,606). Each patient was examined from the index date until the occurrence of DVT or PE, death or withdrawal from the NHI program, or the end of 2011. The incidence rate of DVT was 7.94/10,000 person-years for the non-gallstones cohort and 9.64/10,000 person-years for the gallstones cohort (hazard ratio (HR) = 1.35, 95% confidence interval (CI) = 1.25–1.47), respectively (p < 0.001). The incidence rate of PE was 3.92/10,000 person-years for the non-gallstones cohort and 4.65/10,000 person-years for the gallstones cohort (HR = 1.35, 95% CI = 1.20–1.53), respectively (p < 0.001). The cumulative incidence of DVT (6.54/10,000 person-years vs 14.6/10,000 person-years, adjusted hazard ratio (aHR) = 0.60, 95% CI = 0.54–0.67) and PE (3.29/10,000 person-years vs 6.84/10,000 person-years, aHR = 0.67, 95% CI = 0.58–0.77) for gallstones patients was lower in the cholecystectomy cohort than that in the non-cholecystectomy cohort after adjustment for age, sex, urbanization level, occupation, frequency of medical visits, history of pregnancy, and comorbidities (log-rank test, p < 0.001). Our findings indicate that the risk of DVT or PE in patients with gallstones was greater than those without gallstones. However, the risk of DVT and PE in the patients with gallstones would decrease after cholecystectomy. This area of research needs more studies to ascertain the pathogenesis for the contribution of gallstones to the development of VTE and the protective mechanisms of cholecystectomy against the development of VTE.

Cholecystectomy for Gallstone: Types and Findings

Gall stone disease remains a common and significant cause of suffering in most parts of the world. Gallstones are the most common biliary pathology. A descriptive study covered 80 patients underwent surgical treatment for gallstone diseases. Ultrasound study and plain abdominal X-ray were done to confirm the presence of gallstone. More than half of the sample 58.8% were in the oldest age group 50-69 year. Female were 68(85%) and the remaining 12(15%) patients were male. Most of patients 60(75.0%) operated upon by open cholecystectomy, laparoscope used in 18(22.5%). The main finding on exploring the abdomen was inflammatory adhesion in 54(67.5%) of the patients, thick wall gallbladder came next in 12 (15%) patients. Many complications and clinical findings associated with gallstone, some of them are serious other are even fatal. That is why cholecystectomy is highly indicated even for silent gallstone. Keywords: Gallstone, Jaundice, Cholecystitis, Surgery, Laparoscopy DOI: 10.7176/JHMN/71-09 Publication date: February 29 th 2020

Repeat liver resection for pure large cell neuroendocrine carcinoma of the gallbladder: a favorable outcome

BackgroundThe pure large cell type is a rare variant of primary neuroendocrine carcinoma of the gallbladder. Few reports have mentioned extended survival. Although a multimodal treatment has been described in the treatment of such rare disease, redo liver resection has not yet been mentioned.Case reportA 67-year-old lady was found to have poorly differentiated, high grade, pure large cell neuroendocrine tumor of the gallbladder after cholecystectomy for gallstones. After the diagnosis, staging workup showed a lesion in segment IVB/V of the liver, and chromogranin was elevated (982 mcg/L). The patient underwent central inferior hepatectomy and wedge excision of a lesion in segment III (discovered intra-operatively), with hilar lymphadenectomy. Three months after the first liver resection, she developed a new liver lesion II/III and underwent left lateral liver resection. The patient remained disease-free for 4 months following the second liver resection but then developed recurrent liver disease and was started on chemotherapy. Further progression led to multi-organ failure and death at 26 months from initial diagnosis.ConclusionThis is the first reported repeat liver resection in such a rare disease that has led to extended overall survival. We suggest that a group of selected patients with this rare malignancy, and liver-limited disease, may benefit from repeated liver resection.

Upside-Down Appendix: Report of a Rare Case

Intestinal malrotation is a rare disorder that is usually diagnosed in infancy or childhood. In adults, it can manifest with a broad range of symptoms, ranging from acute abdomen to vague abdominal complaints, or it may be discovered incidentally during investigation or laparotomy for unrelated disease. Among types of intestinal malrotation, it is rare for the appendix to be rotated into the subhepatic space “upside-down appendix”. An 83-year-old woman underwent laparoscopic cholecystectomy for gallstones. During intraperitoneal lavage, the appendix was found to be in the subhepatic space. Review of preoperative abdominal computed tomography (CT) showed that the cecum and appendix had rotated into the subhepatic space. Postoperative barium enema examination confirmed that the appendix was located in the right upper quadrant of the abdomen. With advances in imaging and surgical techniques, asymptomatic malrotation is being detected with increasing frequency. An atypically located appendix can manifest with atypical presentation, which may result in misdiagnosis. Clinicians should be aware that the appendix can have an atypical location.

Increases in Cholecystectomy for Gallstone Related Disease in Sub-Saharan African: Analysis of a Nationwide Cohort

Increases in Cholecystectomy for Gallstone Related Disease in Sub-Saharan African: Analysis of a Nationwide Cohort

Importance of Routine Histopathology of Gallbladder after Elective Cholecystectomy for Gallstones

Introduction: Gallstones are the hard deposits in the gallbladder, which is a sac – like organ lying on the inferior surface of liver in the right upper quadrant of abdomen. Cholecystectomy is the first line surgical procedure to manage symptomatic gallstone. Carcinoma gallbladder carries worst prognosis of all cancer mortality and seen in patients with chronic cholecystitis due to cholelithiasis. The purpose of conductingthis study was to highlight the fact, that the histopathology of the gallbladder in Pakistan is only restricted to those specimens, which are associated with macroscopic abnormalities.Objective: The frequency of gallbladder carcinoma in routine histopathology after elective Cholecystectomy for gallstones who did not show any macroscopic findings preoperatively.Material and Methods: This cross sectional study of 250 patients of both gender aged between 18 – 60 years was conducted in surgical OPD/North Surgical Unit of Mayo Hospital, Lahore in one year duration from 01-01-2014 to 31-12-2014. The non-probability purposive sampling technique was used in this study. Informed consent was taken from all the patients. Their demographics like name, age, gender and address were noted. Open / laparoscopic cholecystectomy was performed depending upon patient’s choice. All gallbladder specimens, those with no obvious gross abnormalities were sent for histopathology (Gross findings, histopathological diagnosis). All data was recorded on a pre-designed proforma and analyzed using SPSS version 20. Mean and standard deviation were used to express the continuous variables like age, stone size and duration of disease. All qualitative variables like gender, number of stones and gallbladder carcinoma were presented in the form of frequency and percentages. Stratification was done for duration of disease, number of stone, size of stone and gender to address effect modifiers. Post stratification chi-square test was applied keeping P-value ≤ 0.05 as significant.Results: In this study the mean age of the patients was 39.52 ± 12.38 years. Among 250 patients, 75 (30%) were males and 175 (70%) females. The mean duration of disease was 5.61 ± 2.75 months. Gallbladder carcinoma on routine histopathology after elective Cholecystectomy was observed in 18 (7.2%) patients whereas 232 (92.8%) patients did not have gallbladder carcinoma. All of the 18 patients who had carcinoma were females which showed a highly significant difference (p &lt; 0.05). Among 153 cases with &lt; 7 mm stone size, carcinoma was observed in 11 patients and in 97 cases with ≥ 7 mm stone size, carcinoma was observed in 7 cases. Among 124 cases with &lt; 5 months of duration of disease, carcinoma was observed in 9 patients and in 126 cases with ≥ 5 months of duration of dis-ease, carcinoma was observed in 9 cases. Among 93 cases with &lt; 2 stones, carcinoma was observed in 7 patients and in 157 cases with ≥ 2 stones, carcinoma was observed in 11 cases. Statistically insignificant difference was found between the duration of disease, number and size of stones and carcinoma of the patients (P &gt; 0.05).Conclusion: Although the frequency of gallbladder carcinoma on histopathology is low, but not negligible, therefore histopathology of gallbladder specimen is necessary to rule out carcinoma.

Anaesthetic management for laparoscopic cholecystectomy in a child

Laparoscopic surgical techniques offer several advantages over conventional open surgery. However, anaesthesia for laparoscopic surgical procedures is challenging due to various associated physiological consequences mainly of intra-peritoneal carbon dioxide insufflation and positioning. Gall stone disease is rare in pediatric age group and therefore, experience of anaesthetic management in such a condition is limited. Here we describe anaesthetic management of a 56-month-old male child scheduled for laparoscopic cholecystectomy for gall stone disease.Journal of Society of Anesthesiologists 2014 1(2): 83-85

Increased Risk of Depressive Disorder following Cholecystectomy for Gallstones.

BackgroundPrior studies indicate a possible association between depression and cholecystectomy, but no study has compared the risk of post-operative depressive disorders (DD) after cholecystectomy. This retrospective follow-up study aimed to examine the relationship between cholecystectomy and the risk of DD in patients with gallstones in a population-based database.MethodsUsing ambulatory care data from the Longitudinal Health Insurance Database 2000, 6755 patients who received a first-time principal diagnosis of gallstones at the emergency room (ER) were identified. Among them, 1197 underwent cholecystectomy. Each patient was then individually followed-up for two years to identify those who were later diagnosed with DD. Cox proportional hazards regressions were performed to estimate the risk of developing DD between patients with gallstone who did and those who did not undergo cholecystectomy.ResultsOf 6755 patients with gallstones, 173 (2.56%) were diagnosed with DD during the two-year follow-up. Among patients who did and those who did not undergo cholecystectomy, 3.51% and 2.36% later developed depressive disorder, respectively. After adjusting for the patient’s sex, age and geographic location, the hazard ratio (HR) of DD within two years of gallstone diagnosis was 1.43 (95% CI, 1.02–2.04) for patients who underwent cholecystectomy compared to those who did not. Females, but not males, had a higher the adjusted HR of DD (1.61; 95% CI, 1.08–2.41) for patients who underwent cholecystectomy compared to those who did not.ConclusionsThere is an association between cholecystectomy and subsequent risk of DD among females, but not in males.

Prospective evaluation of outcome following laparoscopic cholecystectomy in patients with symptomatic gallstone disease

Background: Laparoscopic cholecystectomy for gallstones picked up on ultrasonography has become a routine surgical practice. During follow up, symptoms persist in many cases indicating that underlying gallstone disease perse might not be fully responsible for the patient's problems. Aims: To identify various preoperative factors that could predict symptomatic outcome after cholecystectomy. Setting and design: Consecutive patients presenting with symptomatic gallstone disease in a tertiary care center in North India over two years were included in the study. Materials and Methods: All patients underwent elective laparoscopic cholecystectomy and were followed up to six months. Persistence of any pre-operative symptoms or emergence of new symptoms was recorded. Statistical analysis: Chi square test and student t test were used and value of P Results: Fifty two cases undergoing laparoscopic cholecystectomy were subjected to analysis. Preoperatively, all patients had biliary symptoms and 71.16% patients reported both biliary and dyspeptic symptoms. At 6 months follow up, biliary symptoms improved in more than 90% cases while dyspeptic symptoms improved in 88% cases. Highly significant ( P P Conclusions: Laparoscopic cholecystectomy significantly improves symptoms (especially biliary symptoms) in Asian population. The patients presenting with predominant dyspeptic and non-specific symptoms should be discouraged to undergo cholecystectomy and counseled regarding poor outcome of surgery.

Encapsulating peritoneal sclerosis with favorable outcome in hemodialysis: an unusual case with a literature review

Encapsulating peritoneal sclerosis is a rare condition of a poorly understood pathogenesis with recognized risk factors, such as medications, surgical interventions, systemic diseases, and malignancies. In endstage renal disease it has been associated with chronic peritoneal dialysis. We hereby report the case of a 59-year-old male hemodialysis patient, who was never treated with peritoneal dialysis and developed an unexplained massive ascites 4 months post laparoscopic cholecystectomy for gallstones. A second laparoscopy and histological evaluation revealed encapsulating peritoneal sclerosis-like findings with parietal peritoneum and spleen involvement. The patient was successfully treated for 12 months with prednisone and tamoxifen. Possible pathogenetic mechanisms of the disease in this case are discussed including peritoneal irritation by chronic cholecystitis, low-grade inflammation of hemodialysis, intraoperative complications and the hypothetical role of oxidized regenerated cellulose used for hemostasis. In conclusion, the suspicion of peritoneal sclerosis should be encountered in cases of unexplained ascites in patients undergoing hemodialysis. The early diagnosis includes laparoscopy and histological evaluation and can result in a good outcome under medical treatment; otherwise, there is a high possibility of bowel obstruction with fatal outcome.

Eosinophilic Cystitis with Eosinophilic Cholecystitis: A Rare Association

We describe a rare case of eosinophilic cystitis associated with eosinophilic cholecystitis in a 30-year-old patient who underwent bladder biopsy for irritative voiding symptoms and routine elective cholecystectomy for gallstones. Diagnosis was confirmed by histopathological examination. The rarity of this condition prompted us to report this entity in which no specific cause could be found.

Safra Taşları İçin Laparoskopik Kolesistektomi Yapılan Hastalarda Volatil Anesteziklerin Oksidatif Stres Üzerine Etkileri

Safra Taşları İçin Laparoskopik Kolesistektomi Yapılan Hastalarda Volatil Anesteziklerin Oksidatif Stres Üzerine Etkileri

Intra-abdominal plexiform neurofibromatosis including periportal, mesentery, and gastrointestinal tract involvement in neurofibromatosis type 1: case report and review of the literature.

We report a case of intra-abdominal plexiform neurofibromatosis, including periportal, mesenteric, and gastrointestinal tract involvement, in a patient with von Recklinghausen's disease/neurofibromatosis type 1 (NF-1). A 26-year-old man with familial NF-1 was admitted to hospital for further examination of an abnormal hepatic mass along the portal vein. Esophagogastroduodenoscopy revealed antral wall thickening and swelling of the papilla of Vater. Mucosal biopsies taken from the duodenum revealed possible ganglioneuromatosis. Abdominal ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging revealed an abnormal periportal mass with serpiginous extension into the liver along the portal vein and the mesentery, which is the typical spread pattern of plexiform neurofibromatosis. A laparotomy and cholecystectomy for gallstones were performed, and this patient was diagnosed as having intra-abdominal plexiform neurofibromatosis. This is the 15th case of intrahepatic periportal plexiform neurofibromatosis and the 16th case of diffuse ganglioneuromatosis associated with NF-1 in the English literature. The imaging findings of the lesion have been followed for 10years; there has been slight growth of the mass, but no malignant transformation has been found. The previously reported cases are reviewed.

Sub-hepatic cholesterol stones indicate a sinister underlying diagnosis

A 68-year man underwent a cholecystectomy for gallstones in 2002 and a total thyroidectomy in 2008 for an adenomatoid nodule. On account of a persistently low serum calcium level since thyroidectomy, the patient had regular routine blood tests. One of these routine tests detected abnormal liver function in September 2009 (alanine aminotransferase 98 IU/l, γ-glutamyl transferase 57 IU/l; normal serum albumin, alkaline phosphatase and total bilirubin). There was no history of excessive alcohol intake nor symptoms of acute infection. Viral antibody titres suggested previous hepatitis A; autoantibody screen detected parietal cell autoantibodies. Liver ultrasound showed a large heterogenous …

Hepatobiliary and pancreatic: Papillary cholangiocarcinoma

Papillary neoplasms of the bile duct are rare. Benign disorders include solitary biliary papillomas and multiple papillomas, either at the same time or at different times (biliary papillotomatosis). Both disorders are thought to be premalignant with the potential for evolution from adenoma to carcinoma. Carcinomas with papillary proliferation in the duct lumen are usually called papillary cholangiocarcinomas. These carcinomas have a distinctive appearance within the bile duct and, in contrast to typical cholangiocarcinomas, rarely show mutations in K-ras or p53 or aberrant expression of matrix metalloproteinase-2 or b-catenin. In addition, biliary papillary tumors appear to share pathological features with intraductal papillary mucinous neoplasms of the pancreas. The most common presenting symptoms are jaundice and pruritis. At endoscopic retrograde cholangiography or magnetic resonance cholangiography, the typical appearance is a dilated bile duct with extensive soft tissue expansion, often involving the common hepatic duct and intrahepatic ducts. A minority of patients have a mucus-filled papilla. Most patients are treated surgically with resection of the affected area, often including a partial hepatectomy. The prognosis is better than that of typical cholangiocarcinomas with a 5 year survival rate ranging from 35% to 60%. The patient illustrated below was a 64-year-old man whose liver function tests had become increasingly abnormal over the previous 2 years. He described fatigue and pruritis over the preceding 2 months. Five years previously, he had an uneventful laparoscopic cholecystectomy for gallstones. Tumor markers including carcinoembryonic antigen and CA19.9 were within the reference range. A computed tomography cholangiogram showed soft tissue expansion of the left hepatic duct extending down to the common hepatic duct. There was marked dilatation of the left hepatic duct and atrophy of the left lobe of the liver (Figure 1). At endoscopic retrograde cholangiography, gelatinous material was noted in a widely-open papilla. Biopsies were taken from the common hepatic duct after which a biliary stent was inserted. Biopsies did not reveal definite evidence of cancer. At laparotomy, choledochoscopy demonstrated a dilated bile duct filled with mucin while the left hepatic duct contained mucin and prominent papillary mucosal projections. The patient was treated with a left hepatectomy, radical resection of the extrahepatic biliary tree and reconstruction by hepatojejunostomy. Histology revealed mucus and papillary fronds covered by predominantly dysplastic intestinal-type epithelium (Figure 2) as well as a small focus of adenocarcinoma.

Douleurs de l’hypochondre droit et fièvre

A 35-year-old woman is referred for right upper quadrant abdominal pain and fever. She had a cholecystectomy for gallstones 4 years previously. An aunt has also had a cholecystectomy. Abdominal ultrasound examination shows numerous hyperechoic foci within the liver and some "comet tail" artifacts. Because of her age (less than 40), the recurrence of biliary symptoms after cholecystectomy, her family history and the intrahepatic hyperechoic foci, the diagnosis of low phospholipid-associated cholelithiasis (LPAC) syndrome is suspected and confirmed by the demonstration of a point mutation of the ABCB4 gene. Therapy by ursodeoxycholic acid (AUDC) is started. Symptoms improve and they disappear completely within a few weeks. The cause, pathophysiology, diagnosis and treatment are reviewed.