Management Of Cholelithiasis Research Articles

The Specific features of pediatric cholelityhiasis. A Literature review.

Cholelithiasis is the occurrence of one or several gallstones in the gallbladder. It can be complicated by choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. The causes of this disorder in the pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, or sickle cell anemia) or non-hemolytic - other hereditary disorders such as cystic fibrosis, Wilson’s disease or ileum disorders, total parenteral nutrition, use of certain medication, choledochal cysts, organ transplantation and, in adolescence, those similar to adult patients (obesity). Most gallstones found in children are cholesterol or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and their complications (such as choledocholithi- asis that requires ERCP). There are also some differential diagnoses that should be taken into consideration before treatment (biliary dyskinesia, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts, as well as pediatric pyelonephritis). The first line of treatment of cholelithiasis is diet, saline infusions and medication, and if cholelithiasis is symptomatic and/or complicated, then cholecystectomy is recommended. The surgical approach may be an open procedure or laparoscopy. Some studies show that injuries of the bile ducts are more common in laparoscopic treatment of pediatric cholelithiasis, but nevertheless it has been shown that with an experienced team and good preparation it is the gold standard in the treatment of pediatric cholelithiasis. We present a comprehensive review of the literature on the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in the pediatric population. Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adults.

Pediatric Cholelithiasis Single Center Experience Results of the Clinic for Pediatric Surgery kcu Sarajevo in Period 2010.-2022

Introduction: Cholelithiasis is occurance of one or several gallstones in the gallbladder. It can be complicated with choledocholithiasis, acute or chronic cholecystitis, cholangitis, biliary pancreatitis, biliary ileus, etc. Causes for this disorder in pediatric population can be hemolytic (hereditary spherocytosis, thalassemia, sickle cell anemia) or non hemolytic - other hereditary disorders as cystic fybrosis, Wilson's disease or ileum disordes, total parenteral nutrition, usage of certain medicaments, choledochal cysts, organ transplantation and, in adolescency, those similar to adult patients (obesity). Mostly gallstones found in children are cholesterol ones or pigmented gallstones. There are many diagnostic imaging methods for objectifying gallstones and its complications (as choledocholithiasis that requires ERCP). There is also some differential dyagnoses that should be taken in consideration before the tretment (billary dyskinesion, Odii sphincter dysfunction, neonatal jaundice, cholestasis, pediatric cholecystitis, pediatric pancreatitis and pancreatic pseudocysts as well as pediatric pyelonephritis). First line of treatment of cholelithiasis is with diet, saline infusions and medicaments and if cholelithiasis is symptomatic and/or complicated then cholecystectomy is recomended. Having in mind operative approach it can be open procedure of laparascopic one. Some study show that injuries of bile ducts are more common in laparascopic tretment of pediatric cholelithiasis but nevertheless it is shown that with experienced team and good preparation this is the golden standard in the treatment of pediatric cholelithiasis. Objectives. Hereby we present a comprehensive review of literature for the clinical presentation, pathophysiology, diagnostic evaluation, and management of cholelithiasis in pediatric population. Methods: Between 2010. and 2022, retrospectively, we explored data points of children who underwent laparoscopic cholecystectomy reviewed with included demographics properties, indication for cholecystectomy, used surgical technique, operative time, complications, and length of hospital stay. We performed 37 laparoscopic cholecystectomies (due to cholelithiasis and one case of cholecystitis without calculi) with 2 conversions to open procedures and via open approach we treated 3 cholecystes in this period. Male to female distribution was: 12 male patients and 25 female patients Results: Thirty-seven children (12 male patients and 25 female patients with ages ranging from 7 to 18 years, mean: 11,9 years) underwent laparoscopic cholecystectomy. The indication for surgery was associated to symptomatic cholelithiasis in almost all patients. The surgery was performed under general anesthesia and classical 4-port approach was done in twenty-two patients, and 2-port approach in combination with 2 portless 2.3-mm percutaneous graspers was used in two patients. The operating time ranged between 45 and 120 minutes (mean: 77 minutes). Two patients were treated by open surgery. Only one patient had leakage due to choledocholithiasis, and open surgery and ERCP had to be performed. Median of hospital stay for all patients was 3-4 days. Conclusion: Laparoscopic cholecystectomy is safe and effective in children, and shows the same advantages reported in adult series.

Clinical Profile and Evaluation of Outcomes of Symptomatic Gallstone Disease in the Senior Citizen Population.

BackgroundThere is a heavy burden of gallstone disease on the world’s population. The incidence and severity of symptomatic cholelithiasis increase with age. There is often a delay in presentation, leading to complicated disease, diagnostic delay, and increased morbidity. There is a paucity of studies on the presentation and management of cholelithiasis in elderly persons from the western part of India. This study aimed to observe the spectrum of presentation and management of symptomatic cholelithiasis in senior citizens.Objectives The primary objective of this study was to describe the presentation, diagnosis and intraoperative findings of symptomatic gallstone disease (GSD) in patients aged over 60 years. The secondary objectives of this study were to find the association of GSD with age, sex, and comorbidities, including diabetes mellitus, hypertension, and thyroid disorders.MethodsAll patients above the age of 60 years presenting to the surgical outpatient and emergency departments from January 2020 to July 2021 with symptomatic GSD were included. Details of history, physical examination, blood investigations, and imaging of the abdomen (ultrasonography and Magnetic Resonance Cholangiopancreaticography, when indicated) were recorded. Patients were managed as per the advice of the treating consultant. Details of management and outcomes, including hospital stay, mortality, and morbidity, were noted. The descriptive data were organised into tables and percentages. The significance of various data and relationships between various variables was analysed using the Pearson chi-square test, Fischer exact test and scatter plots.ResultsA total of 76 patients were evaluated in this study, of which 73.7% were female. The mean age was 70.8 ± 1.7 years. The majority of patients (63.2%) were admitted through the outpatient department (OPD). The most common presenting complaint was abdominal pain (96.1%). Clinical jaundice was noted in 9.2%. Complicated Gall Stone Disease (GSD) was found more commonly in the female population (57.1%). Complicated GSD was more commonly found in patients with diabetes (p=0.075) and hypothyroidism (p=0.057). No association of age with intraoperative complications was noted (p = 0.446).ConclusionSenior citizens can present with both complicated and uncomplicated GSD. GSD, in the presence of hypothyroidism or diabetes mellitus, presents in a much more complicated form. Early surgical intervention in form of laparoscopic cholecystectomy can be beneficial to the patient if diagnosed with symptomatic gallstones. Patients of this age group need not be over investigated if a benign pathology is suspected.

Assessment of Nurses’ Knowledge Regarding Management of Patient’s with Cholelithiasis Disease

Cholelithiasis affects approximately 15% of the US population. Rising trends in obesity and metabolic syndrome have contributed to an increase in diagnosis of cholelithiasis. There are several risk factors for cholelithiasis, both modifiable and non modifiable. Women are more likely to experience cholelithiasis than are men. Pregnancy, increasing parity, and obesity during pregnancy further increase the risk that a woman will develop cholelithiasis. The classic presentation of persons experiencing cholelithiasis, specifically when gallstones obstruct the common bile duct, is right upper quadrant pain of the abdomen that is often elicited upon palpation during physical examination and documented as a positive Murphy’s sign Descriptive Cross-Sectional Design is adopted in the current study to achieve the early stated objectives. The study started from January 2nd, 2021 until May, 20th, 2021. A Non-Probability (Convenience Sample) of (60) nurses were including in the present study. Sample collect from 1, 3,4) and emergency department The results of the present study indicated that the majority of the samples (93.33%) have deficit knowledge, which agree with the results of the study showed that the reasons for lack of nurses’ knowledge regarding from the researchers’ point of view “might be related to lack of continuing educational programs or sessions about Cholelithiasis, supervision, continuous evaluation of nurses’ practice, and cooperation between multidisciplinary health care team members (nurses-physicians). Conclusions according to the present study findings, the researcher can mention the following conclusions:Most of nurses in medical units had knowledge deficit concerning management of cholelithiasis nursing management. It is found that the most of nurses are middle age group within (35-39) years old. It is concludes that the most of nurses are institute and college graduated, most of the nurses years’ experience in medical wards(1-10 years). most of the sample have participating in the sessions training in medical wards but no related to cholelithiasis nursing management. Encouraging nurses to update their information by participating in training sessions and conference inside and outside Iraq to improve their knowledge regarding cholelithiasis nursing management which working in medical wards.

Usefulness of Ursodeoxycholic Acid in Management of Gallstone Disease in Children

Objective − The aim of the study is to assess the usefulness of ursodeoxycholic acid in management of gallstone disease in children. Materials and Methods − The prospective study aimed to assess the management of gallstone disease in children. We analyzed all new cases of cholelithiasis during the period from January 2016 to March 2020. Forty-eight new cases of cholelithiasis were enrolled in the study. The diagnosis was established by ultrasound examination due to different complaints in previously healthy patients, or during regular follow-up visits in patients with a chronic disease. A Student t-test, Fisher’s test and χ2-test were used in the statistical processing, where appropriate. Results − A 6-month course of treatment with ursodeoxycholic acid was conducted in 72.9% of cases (N=35). In 27.1% (N=13) of patients this treatment was not administered. Successful dissolution of gallstones was observed in 31.4% (N=11) of treated patients (N=35), over a period of 1 to 6 months. In the group of nontreated patients (N=13), successful dissolution of gallstones was achieved in 38.5% (N=5). Cholecystectomy was performed in 10.4% (N=5) patients, and 1 patient underwent endoscopic retrograde cholangiopancreatography. No early complications, relapse or postcholecystectomy syndrome were observed in the 12-month follow-up period. Conclusion − Management of cholelithiasis in children can often be a challenge. In a selected patient group, conservative treatment may be successful. Use of ursodeoxycholic acid can lead to dissolution of gallstones in patients with preceding dehydration. The effectiveness of ursodeoxycholic acid, except in children with dehydration, was higher

Postoperative Outcomes after Laparoscopic Cholecystectomy in Elderly Patients

Background: Age is a critical factor influencing the death and morbidities afterward cholecystectomy. It was revealed that laparoscopic cholecystectomy (LC) in the elderly has similar security and effectiveness to those in young people. The gold-standard in the management of cholelithiasis is LC. Objectives: This work was aimed to assess post-operative outcomes of LC between elderly cases and for comparing the post-operative outcome of LC among ages groups >60yrs and <60yrs. Patients and Methods: This prospective study conducted among 68 cases who experienced LC at Damanhur Medical National Institute Hospital. Cases were allocated into 2 groups according to ages: elderly (≥60yrs, n= 38) and young (<60 yrs, n= 35). Results: 68 cases divided into two groups. The mean age is 68.4± 5.7 and 49.1± 10.5 among elderly and younger groups. There is significant difference between groups regarding age and comorbidities. The mean operative time was 62.8± 21.2 and 59.5± 18.7 among elderly and young groups. There is no statistically significant difference between two groups regarding intraoperative data. There is nonsignificant change regarding post-operative outcomes after LC. Conclusion: It could be concluded that laparoscopic cholecystectomy in elderly cases is similar with young cases. Consequently, LC is secure even in the elderly.

Management of cholelithiasis with choledocholithiasis: Endoscopic and surgical approaches.

Gallstone disease and complications from gallstones are a common clinical problem. The clinical presentation ranges between being asymptomatic and recurrent attacks of biliary pain requiring elective or emergency treatment. Bile duct stones are a frequent condition associated with cholelithiasis. Amidst the total cholecystectomies performed every year for cholelithiasis, the presence of bile duct stones is 5%-15%; another small percentage of these will develop common bile duct stones after intervention. To avoid serious complications that can occur in choledocholithiasis, these stones should be removed. Unfortunately, there is no consensus on the ideal management strategy to perform such. For a long time, a direct open surgical approach to the bile duct was the only unique approach. With the advent of advanced endoscopic, radiologic, and minimally invasive surgical techniques, however, therapeutic choices have increased in number, and the management of this pathological situation has become multidisciplinary. To date, there is agreement on preoperative management and the need to treat cholelithiasis with choledocholithiasis, but a debate still exists on how to cure the two diseases at the same time. In the era of laparoscopy and mini-invasiveness, we can say that therapeutic approaches can be performed in two sessions or in one session. Comparison of these two approaches showed equivalent success rates, postoperative morbidity, stone clearance, mortality, conversion to other procedures, total surgery time, and failure rate, but the one-session treatment is characterized by a shorter hospital stay, and more cost benefits. The aim of this review article is to provide the reader with a general summary of gallbladder stone disease in association with the presence of common bile duct stones by discussing their epidemiology, clinical and diagnostic aspects, and possible treatments and their advantages and limitations.

Quality of Life Outcomes Following Single-stage Laparoscopic Common Bile Duct Exploration Versus 2-stage Endoscopic Sphincterotomy Followed by Laparoscopic Cholecystectomy in Management of Cholelithiasis With Choledocholithiasis.

With various studies in the literature showing laparoscopic common bile duct (CBD) exploration to have equal or similar results when compared with endoscopic sphincterotomy (EST) clearance, decision-making in regard to the treatment modality to be used may become debatable. Thus, quality of life (QoL) data may assist both the patient and the clinician in deciding the management of the disease. The present prospective randomized trial was undertaken to compare QoL of patients undergoing treatment with these 2 approaches. The study was conducted March 1, 2013, to September 31, 2016. Consecutive patients with CBD stones were randomized to either laparoscopic CBD exploration with cholecystectomy (group I) and EST followed by laparoscopic cholecystectomy (group II). Diagnosis was confirmed preoperatively using magnetic resonance cholangiopancreatography and/or endoscopic ultrasound. QoL scores were assessed by World Health Organization Quality of Life-Brief Version (WHOQOL-BREF), European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire C30 (EORTC QLQ-C30), and Hospital Anxiety and Depression Scale (HADS) questionnaires. A total of 77 patients with concomitant gallstones and CBD stones were finally recruited (38 patients in group I and 39 patients in group II). The demographic and clinical profiles were similar in both the groups. On EORTC QLQ-C30 questionnaire, there was significant improvement in physical, emotional, and role functioning in both the groups (P<0.01) with no intergroup variation preprocedure or postprocedure. Patients in both the groups reported similar WHOQOL scores with significant improvement postprocedure and minimal intergroup variation. Both the depression and anxiety scores on HADS were comparable between the 2 groups preoperatively and at 3 months postoperatively. Single-stage management of patients with gallbladder and CBD stones and EST followed by laparoscopic cholecystectomy were similar in terms of improvement in QoL.

Haemodynamic Consequences in Immediate Postoperative Period in Comparison between Open and Laparoscopic Cholecystectomy”

Background: Laparoscopic cholecystectomy has emerged as a popular alternative to traditional open cholecystectomy in the management of cholelithiasis. It has several advantages .Pneumoperitoneum and trendelenburg positioning causes release of stress hormones and ultimately changes in hemodynamic parameters. Stretching of peritoneum, abdominal wall associated with postoperative pain. So maintenance of haemodynamic stability, immediate postoperative pain control continues to be a major challenge for the anaesthesiologists.&#x0D; Methods: Sample was selected by non-probability sampling technique in two groups distributed as- Group-L (Laparoscopic cholecystectomy, n=30) and Group-O (opencholecystectomy, n=30). Detailed history taking, physical examination and routine lab investigations were done. Approval of the study was obtained by the local Ethical Committee. Post-operative complications, postoperative pain, frequency and pattern of cardiovascular complications, frequency and pattern of respiratory complications were evaluated and compared between thegroups&#x0D; Result: In both groups female were predominant. In this study haemodynamic status (Heart rate, SBP, DBP, MBP) in different phases of anaesthesia, surgery and postoperative follow-up (at 4th hour, 8th hour, and 12th hour) has been observed.&#x0D; Conclusion: This study confirms the feasibility and safety of laparoscopic cholecystectomy is better than open technique in terms of attenuation of better haemodynamic stability, better postoperative pain control and less requirement of analgesia.&#x0D; J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 184-189

Study on the Anti-lithogenic effect of Tablet Bigol and Shashwat Ghrita in the management of Cholelithiasis (Pittashmari)

Background: Specific medical therapy for cholelithiasis is still an unmet need. Common surgical preference like cholecystectomy and choledochotomy though relieve the agonizing pain but alter digestion process permanently which predisposes the continuance of the presentation like heaviness in the abdomen, heart burn, eructation, lethargy, bowel irregularity in spite of dietary restriction. Aim: The present study intends to study the efficacy of tablet Bigol and Shashwat Ghrita in the management of Pittashmari w.s.r. to Cholelithiasis. Method: In the present study, a total of 30 patients diagnosed with cholelithiasis were selected from OPD and IPD unit of Dr. MN Aagashe Charitable Hospital, Satara, Maharashtra, India. For the clinical study, Tablet Bigol and Shashwat Ghrita was authentically prepared in the Ayurveda Arkashala, Satara and were administered in the dose of 1 gm and 20 ml respectively once a day for the duration of 6 months. Result: It was observed that stone size was reduced in 66.66% patients. In 10% of patients stone size remained unchanged. The drugs caused 2-3 times soft stools in most of the patients and resulted in satisfactory bowel habit. Conclusion: It can be concluded from the present study that Tab. Bigol and Shashwat Ghrita are effective remedies in the management of Pittashmari (cholelithiasis).

Clinical study to evaluate the effectiveness of Narikela Lavana, Navasadara Yuktha Yavakshara in comparision with Surya and Navasadara Paneeya Kshara in the management of Cholelithiasis

Cholelithiasis is a crystalline concretion formed within the gall bladder by accretion of bile components. Cholelithiasis can be considered as Pittashaya Ashmari, but there is no direct reference of this condition available in Ayurveda. In Ayurveda the effective treatment is Paneeya Kshara. Surya and Navasadara Paneeya Kshara is standard one and which is highly effective treatment in the management of Cholelithiasis but, persisting pain, presence of calculi has limited in its use. To overcome the lacunas present study has been carried out. This study was conducted at SJIIM Hospital Bengaluru and total of 40 patients were randomly allotted into two groups namely Group A with trial drug i.e. 2grams each of Narikela Lavana, Navasadara, Yava Kshara orally with Jala once daily in empty stomach in the morning, every day for 28 days and Group B with control drug i.e. 2grams of Surya and Navasadara Paneeya Kshara orally with Narikela Jala once daily in empty stomach in the morning, every day for 28 days. Assessment was made on Subjective and Objective parameters. Observations were made before the treatment and on 15th day and 30th day to know the efficacy of the treatment. The combination of Narikela Lavana, Navasadara Yuktha Yava Kshara showed a positive result.

Prevalence and management of cholelithiasis: A clinical study

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The present study determined cases of gall bladder stones. Materials & Methods: This study was conducted on 75 consecutive cases of cholelithiasis. All patients received antibiotics and routine post- operative care. Patient was properly examined in the postoperative period to note the development in any complication. Patients who undergone lap cholecystectomy were discharged on the third day and open cholecystectomy were discharged on the 7th day, Unless any complications. Patients were advised regarding diet, rest and to visit the surgical OPD for regular follow up. Results: Maximum cases was seen in age group 41-50 years (25) followed by 51-60 years (20). Out of 75 patients, males were 35 and females were 40. Common symptoms was pain in 70, nausea/ vomiting in 35, jaundice in 10 and dyspepsia in 20 patients. USG findings was solitary stone in 20, multiple stones in 60, bile duct stones in 12, thickening of gall bladder in 62, dilated bile duct in 13 and mass in 4 patients. 60 patients undergone laparoscopic cholecystectomy and 15 patients undergone open cholecystectomy. 6 patients had wound infection. 1 patient had post operative bile leak which was managed conservatively and patient recovered. 3 patients had bile duct injury which were repaired on the T-tube. Conclusion: Authors found that the incidence of gallstones was the highest in the 5th and 6th decades of the life with maximum incidence in the 5th decade. Gallstones disease is more common in female. The commonest symptom was pain abdomen and the commonest sign was tenderness in the right hypochondrium. Ultrasonography was the investigation of the choice. It showed multiple gallstones and thickening of the gallbladder in the majority of cases.

Cholelithiasis: A Brief Review on Diagnostic Approach and Management in Clinical Practice

Cholelithiasis is one of the most prevalent diseases in gastroenterology. There are many factors in cholelithiasis, such as genetic, lack of physical activity, obesity, dietary, age, and other comorbidities. Commonly, cholelithiasis occurs asymptomatically; however, Murphy’s sign is one of the most frequent pathognomonic findings in abdominal examination. Ultrasonography is known as the gold standard imaging examination in diagnosing cholelithiasis. The management of cholelithiasis can be divided into two categories, such as medical treatment and surgical treatment, which depends on the patient’s condition.

COMPARISON OF MINI CHOLECYSTECTOMY VERSUS OPEN CHOLECYSTECTOMY IN PATIENTS WITH CHOLELITHIASIS

ABSTRACT&#x0D; Objectives: The objective of this study is to compare the outcome of mini cholecystectomy with open conventional cholecystectomy in the management of cholelithiasis.&#x0D; Study Design: This was a randomized controlled trial.&#x0D; Study Period: Study was conducted in Department Of Surgery, Teaching Hospital Dera Ghazi Khan, from June 2017 to Dec 2017 for a period of six month.&#x0D; &#x0D; Patients and Methods: A total of 100 cases; 50 cases in each group was included in the study. 100 patients were admitted from OPD of Teaching Hospital Dera Ghazi Khan fulfilling inclusion criteria. Demographic information was recorded. All admitted patients were diagnosed on the basis of history, clinical examination and relevant investigations. Written consent was obtained. Data entry and analysis&#x0D; was done by using SPSS 11. Data was analyzed according to the proposed analysis plan.&#x0D; &#x0D; Results: Mean age of all patients was 39.96±3.84 years. Age range of patients was 30-48 years. In Group-A mean hospital stay was 5.38±1.15 and in Group-B mean hospital stay was 3.02±0.58 days respectively. At 1st visit 14(28%) patients in Group-B and only 1(2%) patient in Group-A had wound infection. According to p-value wound infection was significantly associated with treatment group. Patients in Group-A had less infection rate as compared to Group-B patients. i.e. (p-value=0.000) Whereas at 2nd visit 8(16%) patients in Group-B and 3 patients in Group-A suffered from wound infection. At 2nd visit wound infection was statistically same in both treatment groups. i.e. (p-value=0.110). It was observed that in Group-B only 44(88%) of the patients had severe pain whereas only 12(24%) of the patients in Group-A had severe pain. Keeping in mind this results rate of severe pain at 12th hour was high in Group-B patients as compared to Group-A patients. i.e. (p-value=0.000).&#x0D; &#x0D; Conclusion: Mini cholecystectomy is effective and associated with less patients discomfort in terms of post operative pain and infection as well as with less hospital stay.

Dilation of the cystic duct confluence in laparoscopic common bile duct exploration and stone extraction in patients with secondary choledocholithiasis

BackgroundMany options exist for the management of cholelithiasis and secondary choledocholithiasis. Among them, laparoscopic common bile duct exploration (LCBDE) with choledocotomy followed by laparoscopic cholecystectomy has gained popularity. However, efforts should be made to ensure minimally invasive or noninvasive management of the common bile duct (CBD). The purpose of this study was to explore the clinical experience of non-invasive surgical modality, i.e., laparoscopic transcystic dilation of the cystic duct confluence in CBD exploration (LTD-CBDE), including feasibility, safety, adverse events, and incidence.MethodsIn this retrospective analysis, 68 patients were offered the LTD-CBDE technique from December 2015 to April 2018 based on patient’s own intention. During the surgery, the cystic duct confluence was dilated with separation forceps and/or a columnar dilation balloon. Subsequently, CBD exploration and stone extraction were performed with a choledochoscope. The entrance of the CBD was covered with a cystic duct stump wall and was subjected to primary closure at the end of surgery.ResultsForty-nine females and 19 males with cholelithiasis and secondary choledocholithiasis were included. The mean age was 53 years old (18 to 72 year). Of these patients, 62 (91.2%) were successfully treated with the LTD-CBDE technique, and bile leakage was observed in 3 patients (4.4%). The mean operation time was 106 min, and the mean hospital stay was 5.9 days. Among the other 6 patients, 3 were converted to open cholecystectomy due to severe fibrosis, unclear anatomical structure at Calot’s triangle (n = 2) or Mirizze syndrome (n = 1); LCBDE was performed in 3 patients due to cystic duct atresia (n = 2) and low level of flow from the gallbladder duct into the CBD (n = 1). These patients had a smooth postoperative course. In total, 43/68 of the patients presented no radiological evidence of retained CBD stones at the postoperative follow-up (40 patients treated with LTD-CBDE) 1 year later.ConclusionsThe current work suggests that LTD-CBDE for the management of cholelithiasis and secondary choledocholithiasis is a feasible, safe and effective technique with a low complication rate. LTD-CBDE offers another alternative for surgeons to treat patients in similar scenarios. However, additional randomized, controlled studies are needed to demonstrate its efficacy, safety, and impact on CBD stenosis.

Laparoscopic Cholecystectomy of Gallbladder Stone Presenting as Empyema in a 9 Years-Old Boy: A Case Report

Background: The gall bladder stones (GBS) are common disease related to diet habit, obesity, hematological diseases, diabetes mellitus and receiving total parenteral nutrition. GBS is a rare cause of hospitalization of pediatric patients, but have been increasingly diagnosed in recent years due to widespread use of ultrasonography. The aim of this case report study is to determine the clinical presentation, risk factors, valuable diagnostic procedures and outcome of laparoscopic management of cholelithiasis in children. Case report: Our case is a 9 years-old boy with empyemic gallbladder complaining of attacks of colicky epigastric pain associated with recurrent vomiting. On abdominal palpation, there is positive sign of deep tenderness at hypochondrium area and positive murphy sign. He has central obesity with BMI 29.9, skin folds more than 3.5 cm and waist circumference more than 90 cm. He has History of high cholesterol and fatty diet and fast food habit, prolonged intake of vitamin D and positive family history. While, no other associated risk factors was detected in our patient. All laboratory investigations was within normal ranges even for his lipid profile. Although, empyema was present, no leukocytosis was detected. Abdominal ultrasound showed the gall bladder wall is slightly thick surrounded by pericholycystic fluid, solitary gall bladder stone of 3 cm size and normal CBD. While, post-operative histopathological examination revealed thick wall gallbladder with multiple tiny stones of cholesterol type. The patient was treated with laparoscopic cholecystectomy with promising outcome and no complications. Conclusion: Pediatric surgeons should consider cholecystolithiasis as from differential diagnosis of abdominal pain associated with vomiting in children. Empyema of gallbladder should be considered once murphy sign is positive in such child patients. Child obesity, fatty diet, vitamin D deficiency and family history are possible risk factors. Ultrasonography is the mainstay of diagnosis. Laparoscopic cholecystectomy is the appropriate management for symptomatic cholelithiasis in children.

A study of clinical presentations and management of cholelithiasis

Background: Cholelithiasis or gallstones, is one of the most common and costly of all the gastrointestinal diseases. Gallstones are associated with high-calorie diets, type 2 diabetes mellitus, dyslipidemia, hyperinsulinism, obesity, and metabolic syndrome. The aim of the study was to analysis the incidence, clinical presentations, and management of cholelithiasis in tertiary care Hospital at Karimnagar, Telangana, India.Methods: This study was a prospective study; total 50 patients were enrolled in this study. The study was conducted at Department of Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar from September 2016 to September 2017. The data were analyzed and evaluated for clinical profile, management options of cholelithiasis.Results: The present study shows gallstones diseases are a common problem in female population. The female to male ratio is 3:2. Age, gender and incidence statistically there was no significant in this study.Conclusions: Gallstones analysis showed mixed stone in 90% of the cases and cholesterol stones in 8% of the cases as the most common variety. The period of post-operative stay in our study was 7 days for open cholecystectomy and 3 days for laparoscopic cholecystectomy in majority of the cases.

A clinical study and management of cholelithiasis

A clinical study and management of cholelithiasis

The association between bowel obstruction and the management of cholelithiasis and cholecystitis in elderly patients: A population-based cohort study

AimsThis study aimed to evaluate the risk of bowel events among elderly patients treated using only PTGBD (Percutaneous Gallbladder Drainage), or a cholecystectomy on its own, or PTGBD combined with a subsequent cholecystectomy. MethodsA retrospective population-based cohort study was conducted with newly diagnosed cholelithiasis and cholecystitis patients who had no bowel obstruction history and were aged over 65 years during the period of January 1, 2000 to December 31, 2010. These patients were placed into 3 separate study cohorts; PTGBD alone, cholecystectomy alone and PTGBD with subsequent laparoscopic cholecystectomy, with the cohort frequencies matched by age and gender. We defined the index date as the time of the initial cholelithiasis and cholecystitis diagnosis date and began observation and suspended follow-up when the patient had either withdrawn from their health insurance, developed bowel obstruction or reached the date of December 31, 2011. ResultsThe incidences of bowel obstruction were 24.6, 19.2 and 13.6 per 1000 person-years for PTGBD cohort, cholecystectomy cohort and PTGBD respectively, with a subsequent laparoscopic cholecystectomy cohort. Compared with the PTGBD cohort, (which was adjusted for age, gender, CCI score and laparotomy history), the hazard ratio of bowel obstruction was 0.77 (95% Confidence Interval (CI) = 0.59–1.00) and 0.57 (95% CI = 0.43–0.76) for the cholecystectomy cohort and PTGBD with a subsequent laparoscopic cholecystectomy cohort respectively. ConclusionFor treatment of cholelithiasis and cholecystitis in elderly patients, PTGBD with a subsequent cholecystectomy could benefit patients by providing a lower risk of ileus or intestinal obstruction.

Laparoscopic cholecystectomy in acute calculus cholecystitis

Background: Acute calculus cholecystitis was traditionally treated conservatively followed by open interval cholecystectomy. Laparoscopy has revolutionized abdominal surgeries. Laparoscopic cholecystectomy is gold standard in management of cholelithiasis. Role of laparoscopic cholecystectomy in acute calculus cholecystitis is still controversial. Present study is evaluating the role of Laparoscopic cholecystectomy as treatment of acute calculus cholelithiasis. Methods: An observational study was conducted at tertiary care academic hospital and a total of 33 patients were enrolled. The inclusion criteria for enrollment of patients were patient with acute abdomen with clinically and ultrasonologically diagnosed as acute cholecystitis. All patients with Acalculus cholecystitis, Choledocholithiasis, obstructive jaundice, Cholangitis and pregnant patient were excluded from this study. The study factor was standard four port laparoscopic cholecystectomy was performed within 72 hours of onset all patients. The primary outcomes were operative time, intra-operative complications, conversion to open surgery and secondary outcome was postoperative complications.Results: A total of 33 cases were enrolled. The mean age of the patients was 44.00 ± 12.2 years (26-68 years) with female preponderance Mean duration of pain was 1.16 days. Mean Operative time was 102.06 ± 10.36 minutes (60-142 minutes). Post-operative surgical site infection present with 4 (12.1%) patients and post-operative fever in 5 (15.2%) patients. The mean hospital stay was 5.30 ± 1.42 days. The open conversion rate was 9.1% and there were no complications.Conclusions: Laparoscopic cholecystectomy in acute calculus cholecystitis is a safe operative procedure.