IntroductionCholecystectomy is considered the gold standard treatment for symptomatic gallstone disease. In certain cases, due to technical difficulties, a subtotal cholecystectomy may be performed. Between 1998 and 2015, a total of 1 423 080 laparoscopic cholecystectomies were performed. 10 162 patients who underwent completion cholecystectomy were identified and stratified by age (<50 vs. ≥50years). This study examines outcomes and risk factors associated with completion cholecystectomy following partial (subtotal) cholecystectomy, with a focus on age and comorbidity burden.ResultsOlder patients demonstrated significantly higher comorbidity burdens, as reflected by Charlson Comorbidity Index scores. Overall complication rates were substantial (26.3%), including gastrointestinal, infectious, and cardiopulmonary events. Mortality was 2.5% overall but markedly higher in patients aged ≥50years (3.3% vs 0.6%). Length of stay was also longer in older patients.ConclusionsWorse outcomes in older individuals correlated strongly with increased comorbidities rather than age alone. Completion cholecystectomy is frequently performed in complex surgical settings with distorted anatomy, contributing to higher complication rates. However, variability in outcomes across studies suggests that patient selection, operative approach, and baseline health status are key determinants. The study highlights the diagnostic challenge of post-subtotal cholecystectomy cholecystitis and underscores the importance of clinical vigilance. It concludes that careful preoperative risk stratification and patient selection are critical to improving outcomes, as procedural risk is closely tied to underlying health status and case complexity rather than the surgery itself.

Gallbladder and bile duct stones (cholelithiasis and choledocholithiasis) represent a major global health burden. Conventional imaging modalities have well-recognised limitations in sensitivity, operator dependence, and accessibility. Artificial intelligence (AI) has emerged as a potential adjunct to improve diagnostic accuracy, yet the evidence base remains unsynthesised. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Seven major databases were searched without language or date restrictions. Studies evaluating any AI algorithm for the detection, segmentation, or classification of gallbladder or bile duct stones on medical images were included. Risk of bias was assessed with QUADAS-2 and evidence certainty with GRADE and a Qualitative synthesis was performed. Thirteen studies (n > 7,700 patients, > 130,000 images) met inclusion criteria. Owing to substantial clinical and methodological heterogeneity, meta-analysis was not performed and findings were synthesized qualitatively. AI models, predominantly convolutional neural networks applied to ultrasound reported accuracies of 71.5-99.63% and AUC values of 0.79-0.99. Performance was highest for multi-class gallbladder disease classification and choledocholithiasis detection on MRCP. Twelve of 13 studies (92%) carried high risk of bias; overall certainty of evidence was rated very low. AI demonstrates promising diagnostic performance for biliary stones; however, methodological limitations and lack of robust external validation preclude routine clinical adoption. Prospective, multicenter studies with real-world validation are urgently required.

Current guidelines endorse laparoscopy for non-obstetric abdominal surgery during pregnancy regardless of trimester, but recent data suggest trimester-specific fetal risks. This study compared maternal and fetal safety of laparoscopic versus open surgery, focusing on trimester-specific and pathology-stratified outcomes. A systematic review and meta-analysis followed PRISMA 2020 (CRD420261295995). PubMed, Embase and Cochrane Library were searched for comparative studies (randomised controlled trials and cohort studies) of laparoscopic versus open surgery for acute appendicitis, gallstone disease and adnexal masses. Random-effects meta-analysis synthesised data on fetal loss, preterm delivery, maternal complications and hospital stay. Twenty-two studies comprising 28,160 pregnant women (15,786 laparoscopic, 12,374 open) were included. Laparoscopy was associated with a higher risk of fetal loss than open surgery (Odds ratio (OR) 2.02; 95% CI 1.40-2.92; P < 0.001). A first-trimester subgroup analysis showed a persistent trend towards higher fetal loss with laparoscopy (OR 1.35; 95% CI 0.84-2.19). Laparoscopy reduced preterm delivery (OR 0.56; 95% CI 0.34-0.94; P = 0.020) and maternal complications (OR 0.45; 95% CI 0.30-0.68; P < 0.001). Trimester-specific analysis revealed a significantly elevated risk of composite adverse fetal outcomes for laparoscopy during the second trimester (OR 2.35; 95% CI 1.15-4.77; P = 0.020) and a similar trend in the third trimester. Laparoscopy confers maternal benefits and reduces preterm delivery but is associated with higher fetal loss and elevated composite adverse outcomes in the second trimester.

Background: One of the most frequent causes of severe abdominal pain is gallstone-induced pancreatitis, which is characterized by acute exocrine pancreatic inflammation associated with acinar cell damage and both local and systemic inflammatory reactions. Significant morbidity and mortality are linked to it. Aim: The purpose of this study is to assess the clinical characteristics of pancreatitis caused by gallstones and to measure and correlate the levels of serum lipase, lactate dehydrogenase (LDH), and C-reactive protein (CRP). Methodology: This prospective study was carried out in the general surgery department of the Maharishi Markandeshwar Institute of Medical Sciences and Research (MMIMSR), Mullana from September 2024 to April 2026. 55 individuals with pancreatitis caused by gallstones were enrolled. For every patient, a thorough clinical history and examination results were documented. Complete blood counts, liver and renal function tests, serum lipase, serum amylase, serum lactate dehydrogenase (LDH), and C-reactive protein (CRP) were among the laboratory testing. SPSS version 21 was used to analyze the data. Pearson's chi-square test was utilized for statistical analysis, and p &lt; 0.05 was deemed statistically significant. Descriptive statistics were presented as mean and percentage. Results: A total of 55 patients with gallstone-induced pancreatitis were included in the study. The majority of patients belonged to the 31–40 years age group (36.3%), with a mean age of 37 years. Males constituted 61.8% of cases, showing a male predominance. Diabetes mellitus (43.6%) and hypertension (29%) were the most common associated comorbidities. Pain abdomen was the most common presenting symptom and showed strong association with elevated serum lipase and CRP levels. Fever, nausea, vomiting, and abdominal distension were also frequently observed, while jaundice showed comparatively weaker correlation with severity markers. Elevated serum lipase (&gt;390 IU/L) and CRP (&gt;10 mg/L) were observed in 98.2% of patients each, while raised LDH (&gt;350 IU/L) was present in 52.7% of cases. Serum lipase demonstrated the highest diagnostic sensitivity (98.2%), followed by CRP (98.2%), whereas LDH showed a sensitivity of 52.7%. The mean serum lipase, CRP, and LDH levels were 1332.94 IU/L, 138 mg/L, and 418.93 IU/L respectively. Among the study subjects, 80% of patients were discharged successfully, while mortality was observed in 20% of cases. Elevated LDH levels showed the highest association with mortality (37.9%), followed by elevated serum lipase and CRP levels (20.4% each), indicating the prognostic significance of LDH in predicting severe disease and poor outcomes in gallstone-induced pancreatitis. Conclusion: Serum lipase was found to be the most sensitive diagnostic marker, while elevated LDH and CRP showed significant association with disease severity and mortality in gallstone-induced pancreatitis. Clinical features such as pain abdomen, fever, and abdominal distension were strongly associated with severe disease. Early assessment using routine biochemical markers may help in timely diagnosis, risk stratification, and improved patient outcomes.

Cholecystolithiasis is a common condition and most cases are asymptomatic. In symptomatic cases, gallstone disease results in hospitalisation and significant healthcare costs. Laparoscopic cholecystectomy is the standard treatment and is traditionally performed in an inpatient setting. Recent studies indicate that outpatient laparoscopic cholecystectomy may offer comparable safety and effectiveness yet the feasibility and cost-effectiveness are not conclusively defined. This randomised-controlled, open-label feasibility trial will be conducted at two surgical centres in Thurgau, Switzerland. A total of 50 participants will be randomly assigned (1:1) to receive either outpatient or inpatient laparoscopic cholecystectomy. The primary endpoints include feasibility, safety and cost-effectiveness. Secondary endpoints assess mortality, postoperative complications, reinterventions and readmission rates, emergency department visits, pain, length of hospital stay, time to return to work and additional healthcare resource utilisation. The total follow-up will be 14 days. The study has been approved by the local ethics committee and is conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Results will be disseminated through peer reviewed publications and conference presentations. DRKS00039001.

The Parkland Grading Scale (PGS) is a practical intraoperative grading system used to assess operative difficulty during laparoscopic cholecystectomy. This study aimed to investigate the relationship between PGS scores and preoperative inflammatory indices and to evaluate whether these indices were associated with operative severity and intraoperative complexity. This retrospective cross-sectional study included 1054 patients who underwent elective laparoscopic cholecystectomy for gallstone disease between January 2018 and January 2025. Demographic characteristics, laboratory parameters, inflammatory indices, operative duration, conversion rates, and PGS scores were analyzed. Univariate and multivariate logistic regression analyses were performed to identify variables independently associated with higher PGS severity. Receiver operating characteristic (ROC) curve analysis was used to determine diagnostic performance. According to the PGS classification, 451 patients were classified as PGS 1, 146 as PGS 2, 213 as PGS 3, 164 as PGS 4, and 80 as PGS 5. Operative duration and conversion from laparoscopic to open cholecystectomy increased significantly with increasing PGS scores (p < 0.001). In multivariate logistic regression analysis, type 2 diabetes mellitus (T2DM), CRP/albumin ratio (CAR), neutrophil/lymphocyte ratio (NLR), and inflammatory burden index (IBI) were identified as independent predictors of higher PGS scores (all p < 0.001). ROC analysis demonstrated that IBI had the highest discriminatory performance (AUC: 0.792), followed by NLR (AUC: 0.766) and CAR (AUC: 0.764). Preoperative inflammatory indices, particularly IBI, NLR, and CAR, were significantly associated with higher PGS scores and increased operative difficulty in laparoscopic cholecystectomy. These markers may help identify patients with increased operative complexity and improve preoperative surgical planning.

Subtotal cholecystectomy is an important bailout procedure for difficult cholecystitis cases. Two novel closure techniques have been described: the fenestrating method (F-method) using Endoloop ligation and the reconstituting method (R-method) using barbed sutures. This study aimed to compare the short- and long-term outcomes of these two techniques. This retrospective study included 52 patients who underwent laparoscopic subtotal cholecystectomy between January 2022 and December 2025, with 33 patients in the F-method group and 19 patients in the R-method group. The primary outcome was early postoperative complications. The secondary outcomes included late complications, operative time, and remnant gallbladder tissue on imaging. Patients in the R-method group were significantly older (median: 72 versus 62 years, P = .021) and had more severe cholecystitis (Tokyo Guidelines grade ≥ II: 79.0% versus 45.5%, P = .023). Unclear anatomy was more common in the R-method group (84.2% versus 21.2%, P < .0001). Closure time was significantly shorter in the F-method group (4 versus 18 minutes, P < .0001). No bile duct injury, bile leakage, or mortality was observed in either group. Among patients who underwent postoperative imaging, remnant gallbladder tissue was identified in 35.7% of patients in the R-method group and 0% in those in the F-method group (P = .012). One patient in each group developed late complications that required readmission (F-method, common bile duct stone; R-method, remnant cholecystitis). Both methods are safe and have distinct complication profiles. The F-method eliminates remnant gallbladder tissue, whereas the R-method is suitable when complete dissection poses a risk of injury. Technique selection should be based on intraoperative findings.

Intrahepatic lithiasis (IHL), defined as the presence of calculi within the intrahepatic bile ducts proximal to the hepatic confluence, has traditionally been considered rare in Western populations. However, increasing evidence suggests that Low-Phospholipid-Associated-Cholelithiasis (LPAC) syndrome, which is a genetic cholangiopathy caused by ABCB4 variants affecting biliary phospholipid secretion, represents a frequently underrecognized cause of IHL.The imaging spectrum of IHL varies according to stone composition and underlying etiology. In Eastern populations, pigment stones associated with recurrent pyogenic cholangitis prevail, whereas in Western patients, cholesterol microlithiasis characteristic of LPAC syndrome is more common. Targeted hepatobiliary ultrasound remains the cornerstone diagnostic modality, capable of detecting findings that are frequently missed on routine examination. Computed tomography (CT) and magnetic resonancecholangiopancreatography (MRCP) provide complementary information regarding stone characterization, biliary anatomy, and complications.Accurate diagnosis requires familiarity with the major mimickers of IHL, including primary sclerosing cholangitis (PSC), Caroli disease, iatrogenicbiliary strictures, and recurrent pyogenic cholangitis, as well as recognition of imaging pitfalls such as pneumobilia and biliary hamartomas.Greater awareness of LPAC syndrome and careful analysis of biliary imaging patterns may enable radiologists to reframe intrahepatic lithiasisfrom an overlooked finding into a diagnosable and treatable condition.

Modified Frailty Index Predicts Complication Risk Following Laparoscopic Common Bile Duct Exploration.

Robotic assistance may mitigate occupational hazards associated with endoscopic retrograde cholangiopancreatography (ERCP). We evaluated the safety, feasibility, and learning curve of a new ERCP robotic system. In this observational study, 26 patients with common bile duct stones underwent robotic-assisted ERCP; six underwent biliary cannulation alone and 20 underwent stone extraction. For 20 cases with stone extraction, comparisons were performed using 1:1 propensity score matching with conventional ERCP performed by the same operator. The safety outcome was assessed by adverse events. Feasibility outcomes included technical success, procedural time, operator radiation exposure, and learning-curve characteristics. After matching, adverse event rates were similar between groups. Post-ERCP pancreatitis occurred in 15.0% (3/20, robotic) and 10.0% (2/20, conventional) (p=1.000), with no bleeding, perforation, or procedure-related mortality. Biliary cannulation and stone extraction success rates were 100% (20/20) in both groups. Robotic-assisted ERCP had longer procedure time (36.6 vs 17.0 min; p<0.001), but similar cannulation and fluoroscopy times. In robotic-assisted procedures, radiation exposure was markedly lower in the control room than in the operation room (0.10 vs 1.26 μSv; p<0.001). Learning-curve analysis suggested performance stabilization after 10-12 cases. Robotic-assisted ERCP appears safe and feasible, with high technical success and substantially reduced operator radiation exposure.

To construct predictive models for the recurrence of common bile duct stones (CBDS) following endoscopic retrograde cholangiopancreatography (ERCP). This retrospective study analyzed data from 1,130 patients who were randomly divided into a training set (70%) and a test set (30%). Feature selection was performed using the boruta algorithm and multivariable logistic regression (LR), followed by addressing data imbalance through the Synthetic Minority Over-sampling Technique (SMOTE). Predictive models were developed utilizing random forest (RF), extreme gradient boosting (XGBoost), and LR. We optimized these models through random search and ten-fold cross-validation to identify the best parameters. After model development, we compared their area under the curve (AUC), accuracy, recall, precision, F1-score, and decision curve analysis (DCA) to select the most optimal model. Ultimately, the optimal model was interpreted using shapley additive explanations (SHAP). Eight risk factors were identified and used to construct the predictive model, including clinical course, stone diameter, presence of multiple stones, use of biliary stents, alcohol consumption, history of biliary tract operations, presence of CBD stenosis, and endoscopic papillary balloon dilation. The RF model outperformed XGBoost and LR in terms of AUC, accuracy, recall, precision, F1-score, and DCA. The SHAP summary plot, waterfall plot, and force plot provided both overall and local explanations of the RF model. This study successfully identifies high-risk individuals for recurrent CBDS post-ERCP and offers valuable insights for machine learning-assisted clinical decision-making.

This review evaluates the evolving management strategies for common bile duct stones (CBDSs), focusing on standard endoscopic techniques, advanced intraductal interventions for refractory stones, and contemporary minimally invasive surgical options. While endoscopic retrograde cholangiopancreatography with sphincterotomy remains the cornerstone of therapy, recent evidence highlights the efficacy and safety of endoscopic papillary large balloon dilation and single-operator cholangioscopy-guided lithotripsy for difficult and refractory stones. Concurrently, laparoscopic common bile duct exploration has proven effective as a single-stage definitive treatment, demonstrating safety and stone clearance outcomes equivalent to the traditional two-stage endoscopic-surgical approach. The management of CBDSs has shifted from a rigid, standardized protocol to a highly tailored clinical algorithm. No single gold-standard strategy is applicable to every scenario. Optimal outcomes are achieved through a flexible, multidisciplinary approach that customizes intervention based on stone characteristics, patient anatomy, and available institutional expertise.

Endoscopic retrograde cholangiopancreatography (ERCP) is often performed under conscious sedation, which may increase pain and dissatisfaction. Mental health conditions may influence patient-reported experience measures (PREMs), including tolerability. This study explores the association between pre-existing anxiety and/or depression and ERCP tolerability using the validated Patient-Reported Scale for Tolerability of Endoscopic Procedure (PRO-STEP) to address this. We performed a retrospective analysis of prospectively maintained data from an international observational cohort of adult patients undergoing ERCP. Pre-existing anxiety/depression were identified prior to the index procedure and the PRO-STEP questionnaire was used to evaluate peri- and post-procedure outcomes. Univariable and multivariable logistic regressions examined the associations between pre-operative anxiety/depression and peri- and post-operative tolerability and patient-reported health outcomes. Among 3,714 participants, 13% had anxiety and/or depression. The mean age of participants in the control group was 62.3 ± 17.4 years, and 49.9% were female, while in the group with depression and/or anxiety, the mean age was 60.0 ± 16.4 years and 68.3% were female (p < 0.001). Common bile duct stones were the most common indications for ERCP in both groups (41.6% of controls and 42.4% of the depression/anxiety group, p = 0.10). Patients in the depression/anxiety group reported higher rates of opioid use (23.4% vs. 13.8%, p < 0.001), cannabis use (22.8% vs. 10.5%, p < 0.001), and heavy alcohol consumption (5.0% vs. 3.6%, p < 0.001). There were no statistically significant differences between groups in terms of disposition, comorbidities, or procedural parameters. Underlying anxiety and/or depression was significantly associated with increased intra-procedural awareness score > 3 (odds ratio, OR, 1.55, 95% CI 1.23-1.95) and discomfort score > 6 (OR 1.73, 95% CI 1.23-2.43) and with post-procedural scores > 3 for abdominal pain (OR 1.44, 95% CI 1.08-1.93), nausea (OR 2.03, 95% CI 1.43-2.89), and distension (OR 2.12, 95% CI 1.29-3.50). Patients with pre-existing anxiety and/or depression reported significantly worse tolerability of ERCP under conscious sedation. Although further research is needed in this area, staff in gastrointestinal endoscopy units should consider strategies aimed at improving tolerability and, consequently, satisfaction among vulnerable populations.

Gallstones commonly cause emergency surgical admission in older adults and are frequently associated with complications. Although cholecystectomy is recommended in the general population, decision-making is complicated by increased comorbidity and frailty in older patients. Trainee-led prospective multicentre cohort across nine NHS hospitals. Consecutive emergency admissions in patients aged ≥ 70years with radiologically confirmed gallstone disease were recruited (November 2022-March 2024). Data were collected at baseline, 30-days and 1-year, including Gastrointestinal Quality of Life Index (GIQLI) scores. Of 194 patients, 36 (18.6%) underwent emergency cholecystectomy, with 158 (81.4%) managed non-operatively at initial presentation. The non-operative group had greater comorbidity burden and frailty. All emergency operations were started laparoscopically (one conversion) with no major complications; median length of stay was similar (7 vs 5days, p = 0.105). Gallstone-related readmission at 1-year was higher after non-operative management (23.0% vs 2.9%, p = 0.024); non-biliary readmissions were similar. One-year mortality was 12.4% vs 0% (p = 0.06). Baseline GIQLI was similar. At 30-days, emergency cholecystectomy was associated with the greatest difference in GIQLI score compared to the non-operative group (p ≤ 0.007). At 1-year, GIQLI remained higher after emergency cholecystectomy (123.8 vs 115.6, p = 0.039). Forty-three patients had undergone interval cholecystectomy by 1-year. Emergency cholecystectomy in older patients deemed suitable for surgery is associated with reduced gallstone-related re-admissions at 1-year and higher QoL scores. These findings support consideration of surgery in appropriately selected older patients and further randomised research in this higher risk group.

Common bile duct (CBD) stones are a common condition with high recurrence rates of stone and cholangitis. However, whether stone type influences recurrence remains unclear. We retrospectively analyzed 190 patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for CBD stones between January 2014 and December 2023. Patients were categorized into two groups: brown pigment stone (n = 127) and black pigment stone (n = 63). Clinical characteristics were compared and recurrence risk factors were analyzed. This study was approved by the Institutional Review Board of Peking University Third Hospital (Approval No. M2024869) and conducted in accordance with the Declaration of Helsinki (2013 revision). Baseline characteristics were similar between groups, except the brown pigment group had higher rates of prior ERCP (33.1% vs. 17.5%), larger CBD diameter (15 mm vs. 12 mm), and more multiple stones (69.3% vs. 49.2%) (all p < 0.05). Recurrence of CBD stones (35.4% vs. 9.5%) and cholangitis (21.3% vs. 4.8%) was significantly higher in the brown pigment group (p < 0.05), with shorter median stone-free survival (67.0 vs. 82.0 months) and cholangitis-free survival (70.0 vs. 82.0 months). Multivariate analysis identified brown pigment stones (HR = 3.162, 95% CI: 1.337-7.482, p = 0.009) and prior ERCP (HR = 3.254, 95% CI: 1.798-5.888, p < 0.001) as independent risk factors for stone recurrence, while stone diameter ≤ 10 mm was protective (HR = 0.412, 95% CI: 0.220-0.773, p = 0.006). Brown pigment stones (HR = 3.434, 95% CI: 1.026-11.489, p = 0.045) and prior ERCP (HR = 2.398, 95% CI: 1.111-5.173, p = 0.026) also independently predicted cholangitis recurrence. Brown pigment stones carry higher risks of stone and cholangitis recurrence, and ERCP may not be the preferred treatment.

The triglyceride-glucose (TyG) index and its obesity-related derivatives-TyG-body mass index, TyG-waist circumference, TyG-waist-to-height ratio (TyG-WHtR), and TyG-a body shape index (TyG-ABSI)-are emerging surrogates of insulin resistance. Their relationships with gallstone disease in the general population remain unclear. We investigated the associations between TyG-related indices and gallstone disease and compared their discriminatory performance. We performed a cross-sectional analysis of 6551 adults from the 2017 to 2023 National Health and Nutrition Examination Survey. Gallstone disease was defined as a self-reported diagnosis by a physician or other health professional. TyG and its 4 derivatives were calculated from fasting triglycerides, fasting plasma glucose, and anthropometric measures. Survey-weighted multivariable logistic regression was used to estimate odds ratios and 95% confidence intervals for gallstone disease, with stepwise adjustment for sociodemographic, lifestyle, and cardiometabolic covariates. Restricted cubic splines evaluated potential nonlinear dose–response relationships, and receiver operating characteristic curves were used to assess predictive performance. The weighted prevalence of gallstone disease was 10.8% (709/6551). All TyG-related indices were significantly higher in participants with gallstones than in those without (all P < .001). In fully adjusted models, each 1-unit increase in TyG, TyG-WHtR, and TyG-ABSI was associated with 40%, 58%, and 21% higher odds of gallstone disease, respectively (odds ratio [95% confidence interval]: 1.40 [1.15, 1.70], 1.58 [1.41, 1.78], and 1.21 [1.02, 1.44]). Quartile analyses showed clear dose–response patterns for all 5 indices. Receiver operating characteristic analyses indicated that TyG-WHtR had the greatest discriminative ability (area under the curve 0.672), followed by TyG-body mass index (0.649) and TyG-waist circumference (0.643), whereas TyG and TyG-ABSI demonstrated lower area under the curves (~0.59–0.60). Higher levels of the TyG index and its derived measures are independently associated with gallstone disease in US adults. Among these markers, TyG-WHtR shows the best, though modest, performance for identifying individuals at higher gallstone risk.

Helicobacter pylori is an established pathogen in gastroduodenal diseases and has been increasingly implicated in hepatobiliary pathology. Several studies have identified H. pylori DNA and antigens in gallbladder mucosa, bile, and gallstones, yet the exact nature of its association with gallstone disease remains unclear. The objective of the study was to determine the association between H. pylori infection in gallbladder tissue and bile with gallstone disease in patients undergoing elective cholecystectomy. This prospective observational study included 100 adult patients with cholelithiasis undergoing elective cholecystectomy. Intraoperative bile was tested using a rapid urease test (RUT). Excised gallbladders were assessed histologically and immunohistochemically for anti-H. pylori antibodies. Clinical profiles, ultrasonography, and endoscopic findings were recorded. Ethical approval and informed consent were obtained. The mean age was 45.7 years; 71% were females. Typical biliary symptoms were present in 61%. RUT positivity was observed in 45% of bile samples, whereas immunohistochemistry detected H. pylori in 28% of gallbladder specimens. A significant association was observed between RUT positivity and gallbladder tissue positivity (P < 0.001). RUT showed 92.86% sensitivity and 73.61% specificity for gallbladder H. pylori detection. A considerable proportion of patients with gallstone disease demonstrated H. pylori positivity in bile or gallbladder tissue, supporting a possible association between H. pylori infection and gallstone pathogenesis. Further mechanistic and longitudinal studies are warranted.

To investigate the clinical application value of the combined use of 3 endoscopes (laparoscope, choledochoscope, gastroscope) with antegrade nasobiliary drainage in the treatment of common bile duct stones. A retrospective analysis was conducted on 80 patients diagnosed with cholecystolithiasis and choledocholithiasis admitted to Dongshan Hospital from January 2024 to August 2025. According to the bile drainage method, patients were divided into the endoscopic nasobiliary drainage tube group (ENBD group, n = 40), who underwent concurrent 3-endoscope combination with antegrade nasobiliary tube placement, and the T-tube group (n = 40), who underwent 2-endoscope (laparoscope, choledochoscope) combination with T-tube placement. Intraoperative, postoperative, and complication conditions were compared between the two groups. All patients in both groups underwent surgery and had drainage tubes successfully placed, with no fatalities reported. There were no statistically significant differences between the two groups in intraoperative blood loss or postoperative complications (bile leakage, pancreatitis) (P > 0.05). The operation time in the ENBD group was longer than that in the T-tube group (P < 0.05). However, the duration of tube retention in the ENBD group was significantly shorter than that in the T-tube group, with a statistically significant difference (Z = -7.698, P < 0.05). The postoperative hospital stay in the ENBD group was significantly shorter than that in the T-tube group, with statistically significant differences (P < 0.05). The concurrent combined use of 3 endoscopes with antegrade nasobiliary drainage is a safe and effective surgical option for the treatment of selected cases of common bile duct stones.

Gallbladder stones are the most prevalent condition affecting the biliary system, with varying incidence rates worldwide. Given the low occurrence of post-operative infections following laparoscopic cholecystectomy, the necessity of prophylactic antibiotic administration is often debated. Several clinical trials have demonstrated that a single pre-operative dose of antibiotics is just as effective as multiple doses. This study aims to compare the effects of single-dose versus multiple-dose antibiotics in laparoscopic cholecystectomy, specifically regarding post-operative infection-related complications. This prospective comparative study was conducted in a tertiary care hospital, Tamil-Nadu for a period of 18 months. Patients were randomly allocated into the study and control groups using a computer-generated simple randomization sequence in a 1:1 allocation ratio. No block randomization or stratification based on age, ASA grade, or other baseline variables was applied, and single dose of cefoperazone and sulbactam given at the time of induction to one group and in the other group cefoperazone + sulbactum 1 gm 1-0-1 was continued post-operatively in the other group for 5 days and Allocation concealment was ensured using sequentially numbered, opaque, sealed envelopes (SNOSE), which were opened only after patient enrolment. Patients were followed up for four weeks to study the post-operative infections and related complications. Due to the nature of the intervention (single-dose vs. extended antibiotic regimen), blinding was not feasible. The study was therefore conducted as an open-label trial. The majority of participants were between 31 and 40 years old, with a slightly higher proportion of males compared to females. Baseline characteristics were largely comparable between the two groups, except for a significantly higher proportion of ASA Grade II patients in the single-dose group compared to the extended-regimen group (77.8% vs. 57.8%, p = 0.034). The growth of organisms showed no variation between the two groups, and the incidence of surgical site infections (SSIs) was comparable, with no statistically significant difference (p > 0.05). Surgical site infection occurred in 3 of 45 patients (6.7%) in the single-dose group and 2 of 45 patients (4.4%) in the extended postoperative antibiotic group. This difference was not statistically significant p value 0.900. Single-dose prophylactic antibiotic administered at the induction of anesthesia is just as effective as multiple-dose antibiotic therapy continued post-operatively in preventing post-operative infections among patients undergoing laparoscopic cholecystectomy.

Left lateral hepatolithiasis is the most common subtype of intrahepatic bile duct stones. Although minimally invasive left lateral sectionectomy (MLS) is widely applied, postoperative stone recurrence remains frequent, particularly in the B4 bile duct. This study aimed to evaluate the clinical value of a classification based on B4 bile duct orifice involvement and to explore optimal minimally invasive surgical strategies. A retrospective analysis was performed on 238 patients with left lateral hepatolithiasis who underwent minimally invasive surgery between January 2015 and October 2024. Patients were classified into B4 type (stones compressing or obstructing the B4 bile duct orifice) and Non-B4 type. Perioperative outcomes, postoperative complications, stone recurrence, and long-term outcomes were compared. Subgroup analyses were conducted in B4-type patients undergoing MLS or conversion to middle hepatic vein-guided anatomical left hemihepatectomy combined with transhepatic lithotomy (MATL). Logistic regression analyses were used to identify independent risk and protective factors. Compared with the Non-B4 group, B4-type patients had longer operative time, greater blood loss, and significantly higher rates of bile leakage and stone recurrence. Multivariate analysis identified B4 bile duct orifice involvement as an independent risk factor for postoperative bile leakage (OR 16.58, p < 0.001) and stone recurrence (OR 30.87, p < 0.001). Conversion to MATL was an independent protective factor against bile leakage (OR 0.04, p = 0.003) and stone recurrence (OR 0.10, p = 0.003). In B4-type patients, MATL was associated with lower complication and recurrence rates without increasing perioperative risk. Left lateral hepatolithiasis involving the B4 bile duct orifice represents a more complex subtype with higher surgical risk and recurrence potential. Individualized surgical planning based on detailed preoperative imaging and intraoperative findings is essential. MATL may be a valuable option in selected B4-type patients.