Gallbladder Pathology Research Articles

BN SO29 - Overinvestigation and unnecessary surgery for Gallbladder Polyps: An audit of compliance with ESGAR guidelines

Abstract Background Incidental gallbladder polyps are increasingly reported on abdominal ultrasound and have a theoretical association with increased risk of gallbladder cancer. Most gallbladder polyps are actually gallstones and there is little evidence for any survival benefit or reduced rates of gallbladder cancer in patients under ultrasound surveillance. ESGAR guidelines attempt to standardize and rationalize surveillance protocols, balancing the risks of missed early cancers versus the costs of surveillance investigations. This audit aims to assess the investigation and management of gallbladder polyps as per ESGAR guidelines at a single NHS trust. Method An audit was conducted at a single NHS Trust in England. Searches were conducted on the electronic patient record for patients coded for K82.8 (Gallbladder pathology: other) from 01/01/2022 to 31/12/2023. Patient records were examined for radiological imaging confirming diagnosis of gallbladder polyp. Data was analysed using Microsoft excel and compared with the 2021 ESGAR guidance on management of gallbladder polyps. Results 97 patients were included. All polyps were diagnosed with abdominal ultrasound. Patients had, on average, two ultrasounds. 51% were seen in outpatients clinic. 35 patients (36%) underwent laparoscopic cholecystectomy (including all patients with a polyp >10mm). Histology confirmed diagnosis of cholecystitis (69%), pseudopolyp (9%), gallbladder polyp (6%) and IPMN (3%). 74% (26/35) of patients that underwent cholecystectomy had biliary symptoms and 77% (20/26) had cholecystitis confirmed by histology. Despite having biliary symptoms at first assessment, 47% of polyp patients went on to have two ultrasounds and two clinic appointments. Conclusion The study confirms that the majority of ultrasound detected polyps are not neoplastic, and patients undergo multiple hospital visits, incurring significant non-therapeutic costs. Adherence to ESGAR guidelines is inconsistent. In the symptomatic cohort, however, a low threshold for laparoscopic cholecystectomy should be considered given the high likelihood of underlying stones.

Xanthogranulomatous Cholecystitis: A Retrospective Review of Clinical Diagnosis and Treatment from a Single Center.

The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis.

Should Gallbladder Pathologies Be Investigated in Patients With Colon Polyps?

Background Data regarding the frequency of development of gallbladder pathologies in patients with colon polyps are quite limited and heterogeneous. Hence, this study aimed to investigate whether colon polyps cause an increased risk of developing gallbladder pathologies and the necessity of ultrasonographic screening. Methodology This retrospective, cross-sectional study was conducted among adult patients who underwent a colonoscopy and hepatobiliary ultrasound as part of their health check-up from January 2018to January 2023. The frequency, etiological factors, and association of gallbladder pathologies with colon polyps were investigated. Results A total of 128 patients were included in the study. When the distribution of colon polyp pathology was examined, 78.9% (n = 101) were adenomas, 18.8% (n = 24) were non-neoplastic polyps, and 2.3% (n = 3) were adenocarcinomas. The rate of patients with gallbladder stones was 10.9% (n = 14) and the rate of patients with polyps was 18.8% (n = 24). On multivariate logistic regression analysis, variables found to be significant for the development of gallbladder pathologies were determined as obesity, hyperlipidemia, and polyp's distal colon location. Conclusions Obesity and metabolic syndrome were among the etiological factors in this patient group. Hepatobiliary ultrasound, a non-invasive and inexpensive examination, is useful in patients with colon polyps.

Gallbladder and biliary pathology: lessons learned from multidisciplinary conference.

The radiologic diagnosis of biliary disease can be challenging due to atypical or delayed presentation, rare or less common entities, and imaging overlap of benign and malignant processes. Establishing a specific diagnosis, when possible, is important to avoid progression of infections to sepsis and multiorgan failure, and for appropriate staging and management in cases of malignancy. Gallstones are the most common biliary disease, and along with stone-related complications, including cholecystitis and choledocholithiasis, constitute the majority of acute biliary pathology. Late and atypical manifestations of acute cholecystitis demonstrate imaging overlap with primary gallbladder cholangiocarcinoma, especially with cases of exuberant inflammatory reaction such as xanthogranulomatous cholecystitis. Additional challenging scenarios related to gallbladder disease, that may be benign or malignant, include adjacent fistulas and lymphadenopathy. Dropped gallstones, especially in atypical locations, may be misdiagnosed as neoplastic. Recurrent cholecystitis after cholecystectomy, whether related to subtotal cholecystectomy or to stumpitis, is another entity that can be confusing to the radiologist with a documented history of cholecystectomy. Inflammatory and autoimmune conditions, such as pseudotumors and IgG4 disease, are a less common but not infrequent cause of diagnostic dilemma. Furthermore, biliary strictures and hepatobiliary cystic lesions can be benign or malignant and could constitute a diagnostic and management challenge. The goal of this manuscript is to present the lessons learned from multidisciplinary conferences on the above entities and suggest tips and pearls to maximize the value of radiologists' contribution to patient management.

Assessment of fasting gastric volume using ultrasound in patients undergoing cholecystectomy and other elective surgeries: A prospective observational study

ABSTRACT Background: Prevention of pulmonary aspiration is an important aspect of anaesthesia practice. Strictly following the pre-operative fasting guidelines can pre-empt pulmonary aspiration in most patients undergoing elective surgeries. Ultrasonographic assessment of patients scheduled for laparoscopic cholecystectomy with symptomatic gall bladder disease has shown a higher incidence of a full stomach. Aim: The primary objectives of this study were to assess and compare gastric volume and contents in fasted patients undergoing elective laparoscopic cholecystectomy and other elective surgeries and to evaluate the relationship of fasting gastric volume and contents with other comorbidities and body mass index (BMI). Materials and Methods: On the day of surgery, hours of fasting were noted. Patients scheduled for laparoscopic cholecystectomy were in Group L, and patients scheduled for other surgeries were in Group O. Ultrasonography was performed before induction of anaesthesia in the pre-operative room by an experienced anaesthesiologist. The patients were classified based on the Perlas grading scale. To assess the risk of aspiration, the classification previously established by Ven de Putte and Perlas was used. Sixty patients were included in Group L and 60 patients in Group O. Results: The incidence of a full stomach was 3.33% in Group O and 20% in Group L. There was no significant association between BMI and gastric residual volume (GRV) in this study. There was no significant difference between GRV between diabetic and non-diabetic patients in Group L and Group O. Conclusion: Patients with gall bladder pathologies scheduled for cholecystectomy could have delayed gastric emptying; therefore, anaesthesiologists should be cautious, and bedside assessment tools such as ultrasound, which is easy and non-invasive, should be utilised to stratify the risk of aspiration in such patients.

Quantification of Salmonella enterica serovar Typhimurium Population Dynamics in Murine Infection Using a Highly Diverse Barcoded Library.

Murine models are often used to study the pathogenicity and dissemination of the enteric pathogen Salmonella enterica serovar Typhimurium. Here, we quantified S. Typhimurium population dynamics in mice using the STAMPR analytic pipeline and a highly diverse S. Typhimurium barcoded library containing ~55,000 unique strains distinguishable by genomic barcodes by enumerating S. Typhimurium founding populations and deciphering routes of spread in mice. We found that a severe bottleneck allowed only one in a million cells from an oral inoculum to establish a niche in the intestine. Furthermore, we observed compartmentalization of pathogen populations throughout the intestine, with few barcodes shared between intestinal segments and feces. This severe bottleneck widened and compartmentalization was reduced after streptomycin treatment, suggesting the microbiota plays a key role in restricting the pathogen's colonization and movement within the intestine. Additionally, there was minimal sharing between the intestine and extraintestinal organ populations, indicating dissemination to extraintestinal sites occurs rapidly, before substantial pathogen expansion in the intestine. Bypassing the intestinal bottleneck by inoculating mice via intravenous or intraperitoneal injection revealed that Salmonella re-enters the intestine after establishing niches in extraintestinal sites by at least two distinct pathways. One pathway results in a diverse intestinal population. The other re-seeding pathway is through the bile, where the pathogen is often clonal, leading to clonal intestinal populations and correlates with gallbladder pathology. Together, these findings deepen our understanding of Salmonella population dynamics.

Practical approach to linear endoscopic ultrasound examination of the gallbladder

The gallbladder (GB) is a susceptible organ, prone to various pathologies that can be identified using different imaging techniques. Transabdominal ultrasound (TUS) is typically the initial diagnostic method due to its numerous well-established advantages. However, in cases of uncertainty or when a definitive diagnosis cannot be established, computed tomography (CT) or magnetic resonance imaging may be employed to provide more detailed information. Nevertheless, CT scans may sometimes offer inadequate spatial resolution, which can limit the differentiation of GB lesions, particularly when smaller yet clinically relevant abnormalities are involved. Conversely, endoscopic ultrasound (EUS) provides higher frequency compared to TUS, superior spatial resolution, and the option for contrast-enhanced harmonic imaging, enabling a more comprehensive examination. Thus, EUS can serve as a supplementary tool when conventional imaging methods are insufficient. This review will describe the standard EUS examination of the GB, focusing on its endosonographic characteristics in various GB pathologies.

Laparoscopy experience in East, Central, and Southern Africa: insights from operative case volume analysis

BackgroundWith the primary objective of addressing the disparity in global surgical care access, the College of Surgeons of East, Central, and Southern Africa (COSECSA) trains surgeons. While sufficient operative experience is crucial for surgical training, the extent of utilization of minimally invasive techniques during COSECSA training remains understudied.MethodsWe conducted an extensive review of COSECSA general surgery trainees' operative case logs from January 1, 2015, to December 31, 2020, focusing on the utilization of minimally invasive surgical procedures. Our primary objective was to determine the prevalence of laparoscopic procedures and compare this to open procedures. We analyzed the distribution of laparoscopic cases across common indications such as cholecystectomy, appendicitis, and hernia operations. Additionally, we examined the impact of trainee autonomy, country development index, and hospital type on laparoscopy utilization.ResultsAmong 68,659 total cases, only 616 (0.9%) were laparoscopic procedures. Notably, 34 cases were conducted during trainee external rotations in countries like the United Kingdom, Germany, and India. Gallbladder and appendix pathologies were most frequent among the 582 recorded laparoscopic cases performed in Africa. Laparoscopic cholecystectomy accounted for 29% (276 of 975 cases), laparoscopic appendectomy for 3% (76 of 2548 cases), and laparoscopic hernia repairs for 0.5% (26 of 5620 cases). Trainees self-reported lower autonomy for laparoscopic (22.5%) than open cases (61.5%). Laparoscopy usage was more prevalent in upper-middle-income (2.7%) and lower-middle-income countries (0.8%) compared with lower-income countries (0.5%) (p < 0.001). Private (1.6%) and faith-based hospitals (1.5%) showed greater laparoscopy utilization than public hospitals (0.5%) (p < 0.001).ConclusionsThe study highlights the relatively low utilization of minimally invasive techniques in surgical training within the ECSA region. Laparoscopic cases remain a minority, with variations observed based on specific diagnoses. The findings suggest a need to enhance exposure to minimally invasive procedures to ensure well-rounded training and proficiency in these techniques.

Atlas for Cholangioscopy and Cholecystoscopy: A Primer for Diagnostic and Therapeutic Endoscopy in the Biliary Tree and Gallbladder.

Percutaneous endoscopy of the biliary system (cholangioscopy) and gallbladder (cholecystoscopy) has significantly impacted diagnostic and therapeutic approaches to many diseases in interventional radiology, overcoming previous challenges related to scope size and rigidity. The current endoscopes offer enhanced maneuverability within narrow tubular structures such as bile ducts. Before endoscopy, reliance on 2D imaging modalities limited real-time visualization during percutaneous procedures. Percutaneous endoscopy provides 3D perspectives, enabling a better appreciation of normal structures, targeted biopsy of lesions, and accurate deployment of therapeutic interventions. This review aims to explore percutaneous endoscopic findings across various biliary and gallbladder pathologies.

How CEUS improves gallbladder pathology evaluation. A comprehensive pictorial and review of the literature.

Gallbaldder disorders represent a prevalent pathology encounterd in daily practice, both in emergency and ambulatorysettings. Transabdominal ultrasound has a high accuracy for the diagnosis of gallstones and acute cholecystitis. Contrast enhancedultrasound (CEUS) can depict and characterized the vascular pattern in cases of inflammatory or malignant processes.In an emergency situation such as acute cholecystitis in patients with comorbidities, CEUS can acurate identify a gangrenouscholecystitis; subsequently the medical management can rely on this technique. The differential diagnosis of benign vs malignantpathology, in cases of segmental or diffuse wall thickening, can also benefit from CEUS. In this paper we aimed to discussand to illustrate the role of CEUS in gallbladder pathology.

Prevalence of different gallbladder pathologies and usefulness of mucin histochemistry in early diagnosis of metaplasia and carcinoma of gallbladder

Background: Non-neoplastic and neoplastic diseases of gallbladder are most prevalent in northern and north-eastern states of Uttar Pradesh, Bihar, Orissa, West Bengal, and Assam in India. Chronic cholecystitis, the most common pathology of gallbladder is often associated with metaplasia of epithelium, leading to increased susceptibility to malignant transformation. Along with histopathological examination, mucin histochemistry is useful in early detection of metaplasia and thereby predicting metaplasia-dysplasia-carcinoma sequence. Aims and Objectives: The objective of this study was to estimate the prevalence of neoplastic and non-neoplastic diseases of gallbladder and to determine the usefulness of mucin histochemistry in early diagnosis of metaplasia and carcinoma of gallbladder. Materials and Methods: A cross-sectional observational study was conducted in R. G. Kar Medical College, Kolkata, over a period of 18 months. Total 401 cholecystectomy specimens were studied. In every case, following sequence of examinations was performed-gross examinations, histopathological examination, and mucin histochemistry. Results: All the available information was meticulously documented in tables and charts, software was used to calculate the statistical significance and efficacy of mucin histochemistry as a diagnostic tool. Conclusion: We found that mucin histochemistry is statistically significant and has positive predictive value in early diagnosis of metaplasia and carcinoma of gallbladder.

Incidental wandering gall bladder: a rare case report

The pre-operative diagnosis of wandering gallbladder is challenging until complicated by torsion or necrosis. Ultrasonography remains the mainstay radiological investigation for gall bladder pathologies. Computed tomography can be used in complicated cases like gall bladder torsion. Free floating gall bladder may not be appreciated on ultrasonography as in our case report which has been discussed below.

Feasibility of robotic cholecystectomy at an academic center with a young robotic surgery program: a retrospective cohort study with umbrella review

Laparoscopic cholecystectomy (LC) has been standard of care for surgical treatment of benign gallbladder pathology for decades. With the advent of robotic surgical technology, robotic cholecystectomy (RC) has gained attention as an alternative to conventional laparoscopy. This study introduces a single-surgeon experience with laparoscopic versus robotic cholecystectomy and an umbrella systematic review of the outcomes of both approaches. A retrospective chart review was performed at a single institution on a prospectively maintained database of patients undergoing laparoscopic or robotic cholecystectomy for benign gallbladder pathology. An umbrella systematic review was conducted using PRISMA methodology. A total of 103 patients were identified; 61 patients underwent LC and 42 underwent RC. In the RC cohort, 17 cases were completed using a four-port technique while 25 were completed using a three-port technique. Patients undergoing RC were older compared to the LC group (44.78 vs 57.02 years old; p < 0.001) and exhibited lower body mass index (29.37 vs 32.37 kg/m2, p = 0.040). No statistically significant difference in operative time or need for postoperative ERCP was noted. Neither this series nor the umbrella systematic review revealed significant differences in conversion to open surgery or readmissions between the LC and RC cohorts. Three-port RC was associated with reduced operative time compared to four-port RC (101.28 vs 150.76 min; p < 0.001). Robotic cholecystectomy is feasible and safe at a young robotic surgery program in an academic center setting and comparable to laparoscopic cholecystectomy clinical outcomes.

ROBOtic Care Outcomes Project for acute gallbladder pathology.

Robotic cholecystectomy is being increasingly used for patients with acute gallbladder disease who present to the emergency department, but clinical evidence is limited. We aimed to compare the outcomes of emergent laparoscopic and robotic cholecystectomies in a large real-world database. Patients who received emergent laparoscopic or robotic cholecystectomies from 2020 to 2022 were identified from the Intuitive Custom Hospital Analytics database, based on deidentified extraction of electronic health record data from US hospitals. Conversion to open or subtotal cholecystectomy and complications were defined using ICD10 and/or CPT codes. Multivariate logistic regression with inverse probability treatment weighting (IPTW) was performed to compare clinical outcomes of laparoscopic versus robotic approach after balancing covariates. Cost analysis was performed with activity-based costing and adjustment for inflation. Of 26,786 laparoscopic and 3,151 robotic emergent cholecystectomy patients being included, 64% were female, 60% were ≥45 years, and 24% were obese. Approximately 5.5% patients presented with pancreatitis, and 4% each presenting with sepsis and biliary obstruction. After IPTW, distributions of all baseline covariates were balanced. Robotic cholecystectomy decreased odds of conversion to open (odds ratio, 0.68; 95% confidence interval, 0.49-0.93; p = 0.035), but increased odds of subtotal cholecystectomy (odds ratio, 1.64; 95% confidence interval, 1.03-2.60; p = 0.037). Surgical site infection, readmission, length of stay, hospital acquired conditions, bile duct injury or leak, and hospital mortality were similar in both groups. There was no significant difference in hospital cost. Robotic cholecystectomy has reduced odds of conversion to open and comparable complications, but increased odds of subtotal cholecystectomy compared with laparoscopic cholecystectomy for acute gallbladder diseases. Further work is required to assess the long-term implications of these differences. Therapeutic/Care Management; Level IV.

Comparison of postoperative outcomes between different dissection techniques during laparoscopic cholecystectomy in rabbits: randomized study.

Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of gallbladder (GB) disease in small animals. The aims of this study were to investigate and compare the effect of different types of dissectors during LC in rabbits; electrothermal bipolar vessel sealing device (EBVS-LigaSure) and standard electrosurgical dissection (bipolar Maryland) for dissection of the GB in LC, correlating liver function tests (LFTs) in pre and postoperative periods (days 0, 3, 7, 15); macroscopic checking 15 days after surgery through necropsy; histopathological, bacteriological through bacterial growth by culture and intraoperative complications. Twenty rabbits were used, group (n = 10) using EBVS for GB dissection and cystic duct seal (GLL), and group (n = 10) using bipolar dissecting forceps and EVBS for cystic duct seal (GLE). A higher concentration of alkaline phosphatase was observed on GLL 15 days after surgery when compared to GLE. In addition, GLE resulted in a higher concentration of alanine aminotransferase at three days when compared to GLL. In LC no significant statistical differences were found between EBVS and bipolar Maryland; both devices are equally safe and effective in LC. Further studies are required to evaluate the effectiveness of these devices in animals with gallbladder pathologies. Therefore, clinical studies are necessary.

Incidental Primary Cystic Duct Lymph Node Tuberculosis in a 28-year-old Female: A Rare Case Report

Tuberculosis (TB) is an infectious disease caused by acid-fast bacilli Mycobacterium tuberculosis (MTB). The lung remains the most common site involved by it. Extrapulmonary sites of TB are lymph nodes, pleura, bone, joints, urogenital tract, and meninges. Isolated Cystic Duct Tubercular Lymphadenitis (CDL TB) without involving the gallbladder is an uncommon manifestation of TB that primarily affects the lymph nodes around the cystic duct. A multidisciplinary approach is essential for accurate diagnosis and successful management of such cases. The authors hereby present a case of a 28-year-old female, without any evidence of TB elsewhere and an incidental finding of CDL TB. “The patient was sent with a clinical diagnosis of Chronic Calculus Cholecystitis (CCC)”. This highlights the need for comprehensive clinical evaluation and diagnostic investigations to avoid misdiagnosis or delayed management. This underscores the significance of maintaining a high index of suspicion for extrapulmonary TB, particularly in regions where the disease remains endemic. Healthcare practitioners should be vigilant when encountering unusual clinical presentations or when dealing with atypical combinations of gallbladder pathologies, as illustrated by the concurrent occurrence of CDL TB with CC with evidence of Pyloric Metaplasia (PM) and cholesterolosis without cholelithiasis, as in the patient of the present case report.

Wandering gallbladder wrapping hepatoduodenal ligament and mimicking gastrointestinal stromal tumor at imaging. Case report and literature review

Wandering or free-floating gallbladder is a rare anomaly of position of the gallbladder, characterized by an unusually long or absent mesentery. This condition may present clinically as an emergency case of gallbladder torsion or as part of a complex clinical picture, where patients may present symptoms that trace to gallbladder pathology, but show morphologic features that are distant from gallbladder disease. We present a case where a wandering gallbladder wrapping around the hepatoduodenal ligament adhered to the stomach mimicking features of a gastrointestinal stromal tumor at preoperative imaging.

Incidental precancerous and cancerous neoplasms in routine cholecystectomy specimens – A fascinating series of cases in a tertiary care center

Laparoscopic cholecystectomy is one of the most commonly performed surgeries for benign gall bladder pathologies. Pre-cancerous and malignant gall bladder neoplasms often have overlapping non-specific clinical manifestation in their early stages. Radiological findings are also non-specific in the early stages with the presence of cholelithiasis in a significant proportion of cases. Cholelithiasis is said to be one of the important comorbid risk factors for gall bladder carcinoma (GBC) as a source of constant irritation to biliary mucosa. In such cases, cholecystectomy done for benign indications may lead to a histopathological diagnosis of incidental gall bladder carcinomas. Pancreaticobiliary type of adenocarcinoma is the most common subtype of GBC with two described cases in this series. Invasive foci need to be ruled out in. All cases of high-grade biliary intraepithelial neoplasia as were seen in the third case. Intracholecystic papillary neoplasm is a recently described entity with one reported case in this series that was associated with invasive adenocarcinoma. Signet ring adenocarcinoma is a rarely encountered adenocarcinoma in gall bladder with worse outcome. One such case has been described here where the patient has succumbed to death within 3 months of surgery and during the course of adjuvant therapy.

Risk Factors and Prevalence Associated With Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy: A Tertiary Care Hospital Experience in Western Mexico.

Introduction Laparoscopic cholecystectomy (LC) is a common procedure used for the treatment of different pathologies caused by gallstones in the gallbladder, and one of the most common indications is acute cholecystitis. The definitive treatment for acute cholecystitis is surgery, and LC is the gold standard. Nevertheless, transoperative complications (like intraoperative bleeding, anatomical abnormalities of the gallbladder, etc.) of LC and some other preoperative factors (like dilatation of bile duct, increased gallbladder wall thickness, etc.) can cause or be a risk factor for conversion to open cholecystectomy (OC). The objective of this study was to determine the risk factors and prevalence associated with the conversion from LC to OC in patients with gallbladder pathology and the indication for LC. Materials and methods This was a prospective cohort study. We included patients of both sexes over 18 years of age with gallbladder disease. To determine the risk factors associated with conversion, we performed a bivariate analysis and then a multivariate analysis. Results The rate of conversion to OC was 4.54%. The preoperative factors associated with conversion, in the bivariate analysis, were common bile duct dilatation (p=0.008), emergency surgery (p=0.014), and smoking (p=0.001); the associated intraoperative variables were: laparoscopic surgery duration (p <0.0001), Calot triangle edema (p=0.033), incapacity to hold the gallbladder with atraumatic laparoscopic tweezers (p=0.036), and choledocholithiasis (p=0.042). Laparoscopic Surgery duration was the only factor with a significant association in the multivariate analysis (p=0.0036); we performed a receiver operating characteristic (ROC) curve analysis and found a cut-off point of 120 minutes for the duration of laparoscopic surgery with a sensitivity and a specificity of 67 and 88%, respectively. Conclusion The prevalence of conversion from LC to OC is similar to that reported in the international literature. The risk factors associated with conversion to OC, in this study, should be confirmed in future clinical studies, in this same population, with a larger sample size.

Histopathological Changes in the Gall Bladder Mucosa Associated with Helicobacter Pylori Gastritis

Objective: To identify Helicobacter Pylori (HP) gastritis-associated histopathological changes in Gall Bladder (GB) mucosa in patients undergoing cholecystectomy. Methodology This prospective comparative cross-sectional study was conducted in the Gastroenterology department of Liaquat National Hospital, Karachi, Pakistan, from December 2021 to December 2022. The study included all patients admitted with a diagnosis of any Gall Bladder pathology and those who were electively scheduled for cholecystectomy. Participants were categorized into two groups based on the presence of HP: group A (HP positive) and group B (HP negative) in gastric mucosa before cholecystectomy. HP detection was performed using various methods, including HP stool antigen (HPSA), Urea breath test (UBT), HP antibodies, and biopsy confirmation through gastroscopy. Results: The mean age of patients in group A was 42.88 ± 8.28 years, and in group B, it was 43.35 ± 8.74 years (p=0.458). According to the GB histological findings, Chronic cholecystitis with focal Cholesterolosis was significantly more common in group A (75.4%), while Chronic cholecystitis alone was significantly higher in group B (66.2%) (p=0.001). Dysplasia was observed more frequently in group B compared to group A. Erosion was more prevalent in group A, patients than in group B (p=0.001). Although symptom improvement in the HP positive group with persistent symptoms post-eradication was not statistically significant, it did show some improvement (p=0.527). Conclusion: The histological findings of chronic cholecystitis with focal Cholesterolosis were significantly higher in the HP positive group compared to the HP negative group, while chronic cholecystitis alone was significantly more common in the HP gastritis negative group. Some HP gastritis group patients experienced symptom improvement after HP eradication.