Gallbladder Wall Thickening Research Articles

Adenomyomas of the Gallbladder: An Analysis of Frequency, Clinicopathologic Associations, and Relationship to Carcinoma of a Malformative Lesion.

The nature and associations of gallbladder (GB) "adenomyoma" (AM) remain controversial. Some studies have attributed up to 26% of GB carcinoma to AMs. To examine the true frequency, clinicopathologic characteristics, and neoplastic changes in GB AM. Cholecystectomy cohorts analyzed were 1953 consecutive cases, prospectively with specific attention to AM; 2347 consecutive archival cases; 203 totally embedded GBs; 207 GBs with carcinoma; and archival search of institutions for all cases diagnosed as AM. Frequency of AM was 9.3% (19 of 203) in totally submitted cases but 3.3% (77 of 2347) in routinely sampled archival tissue. A total of 283 AMs were identified, with a female to male ratio = 1.9 (177:94) and mean size = 1.3 cm (range, 0.3-5.9). Most (96%, 203 of 210) were fundic, with formed nodular trabeculated submucosal thickening, and were difficult to appreciate from the mucosal surface. Four of 257 were multifocal (1.6%), and 3 of 257 (1.2%) were extensive ("adenomyomatosis"). Dilated glands (up to 14 mm), often radially converging to a point in the mucosa, were typical. Muscle was often minimal, confined to the upper segment. Nine of 225 (4%) revealed features of a duplication. No specific associations with inflammation, cholesterolosis, intestinal metaplasia, or thickening of the uninvolved GB wall were identified. Neoplastic change arising in AM was seen in 9.9% (28 of 283). Sixteen of 283 (5.6%) had mural intracholecystic neoplasm; 7 of 283 (2.5%) had flat-type high-grade dysplasia/carcinoma in situ. Thirteen of 283 cases had both AM and invasive carcinoma (4.6%), but in only 5 of 283 (1.8%), carcinoma arose from AM (invasion was confined to AM, and dysplasia was predominantly in AM). AMs have all the features of a malformative developmental lesion, and may not show a significant muscle component (ie, the name "adeno-myoma" is partly a misnomer). While most are innocuous, some pathologies may arise in AMs, including intracholecystic neoplasms, flat-type high-grade dysplasia or carcinoma in situ, and invasive carcinoma (1.8%, 5 of 283). It is recommended that gross examination of GBs include serial slicing of the fundus for AM detection and total submission if one is found.

Psychological and sociodemographic factors for delayed patient discharge after daycare laparoscopic cholecystectomy.

Objective: To estimate the psychological and sociodemographic correlates of delayed discharge of patients undergoing Elective Laparoscopic Cholecystectomy. Study Design: Retrospective Cross-sectional Descriptive study. Setting: Department of Surgery, Fauji Foundation Hospital. Period: July 2019 and June 2022. Material & Methods: The study comprised reviewing medical records of 160 patients who underwent daycare cholecystectomy. It was noticed from patients’ medical records that patients were carefully selected for daycare surgery. Patients with comorbidities, previous upper intra-abdominal surgery, ultrasound findings of thickened gallbladder wall > 5mm were not offered day care surgery. For data collection a Performa was designed based on literature review. To assess psychological state, we applied Hospital anxiety and depression scale in Urdu. Descriptive statistics were calculated for the sociodemographic variables, mean and standard deviation was found for continuous variables and frequency percentages for categorical variables. Results: One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. One hundred and thirty-one 131 (81.8 percent) of the 160 cholecystectomies could be sent home within 24 hours, whereas 29 (18 percent) required a lengthier hospital stay. In LS group, the postoperative stay range was 2 –19. Observation of postoperative fever (n = 3), surgery-related causes postoperative pain (n= 6), delayed oral diet = 1, retained abdominal drain = 4, and postoperative complications (n= 3). Bowel injury (n = 2) and septicemia (n = 1) were serious postoperative consequences resulting in more prolonged hospital stay. PONV (n = 2), medical causes (n = 3), and patient preference (n = 7) were among the reasons for the prolonged hospital stay. Conclusion: While our study has a few limitations; it is a retrospective review with nonrandomized patient selection and a smaller sample size, we have established safety of day case laparoscopic cholecystectomy in select group of patients. Patients’ personal satisfaction was the most common reason for their overnight admission after day case LC which was because of number of sociodemographic factors.

Exploring the imaging features and treatment options of Mirizzi syndrome

The patient is a 54-year-old female who presented to the emergency department for episodic right biliary colic with nausea and vomiting over the past year. The patient's symptoms warranted multiple emergency department visits, but were self-limiting. During the most recent visit, the patient had a low-grade fever of 99.8°F (96.8°F-99.5°F) and a borderline elevated total bilirubin of 1.2 (0.2-1.2 mg/dL). Abdominal ultrasound revealed cholelithiasis, gallbladder wall thickening, and biliary ductal dilatation. Subsequent MRCP revealed an impacted stone within the gallbladder neck and a prominent common hepatic duct, compatible with Mirizzi syndrome Type I. The obtained imaging combined with clinical correlation in the setting of jaundice and right upper quadrant pain guided the patient's management. A laparoscopic cholecystectomy was performed and the patient was safely discharged the following day.

Can fibrinogen level be a criterion in choosing the treatment option in patients with acute cholecystitis?

We aimed to investigate whether there is a relationship between blood fibrinogen levels during hospitalization of patients hospitalized for conservative treatment due to acute cholecystitis (AC) in our clinic. Patients underwent surgery and were discharged with medical treatment. The files of 118 patients who were hospitalized due to the diagnosis of AC and planned for conservative medical treatment in our clinic between January 2018 and February 2020 were recorded, prospectively. The patients were divided into two groups as those who responded to conservative treatment (Group 1), and those who were operated urgently despite conservative treatment (Group 2). Increase in gallbladder wall thickness, presence of pericholecystic fluid and hydrops sac on ultrasound and computed tomography (CT) were considered significant for the diagnosis of acute cholecystitis. Blood fibrinogen levels were measured in all patients during hospitalization. The mean age of 118 patients included in the study was 58.32 (19-96) years. There were 77 patients in Group 1 and 41 patients in Group 2. Serum fibrinogen level was found to be 298.34±111.7 mg/dl in Group 1 and 637±124.5 mg/dl in Group 2, and a statistically significant difference was found (p<0.001). When the cut-off value for the fibrinogen level was taken as 564.50 mg/dl, the sensitivity and specificity of the test were found to be 75.6% and 61%, respectively in showing surgical treatment. As a result of our study, we concluded that when the data obtained are evaluated, it should be kept in mind that despite medical treatment, there is an urgent need for an operation in patients with acute cholecystitis, and in patients with high plasma fibrinogen level (cut-off) at first admission.

Defining Critical View of Safety During Laparoscopic Cholecystectomy: The Preoperative Predictors of Failure.

Background Defining critical view of safety (CVS) is one of the most crucial steps during laparoscopic cholecystectomy (LC). This study aimed to determine the preoperative predictors of failure to achieve CVS during LC. Methods All patients undergoing LC from December 2020 to July 2022 were prospectively included. Results There were 180 females and 93 males. CVS was achieved during LC in 238 (87.2%) patients. Conversion to open surgery was performed for 11 patients. Bile leak occurred in three patients which resolved spontaneously. No patient developed bile duct injury. On univariate analysis, age, male sex, American Society of Anaesthesiologists (ASA) grading, Murphy's sign, emergency surgery, neutrophil percentage, lymphocyte percentage, gallbladder wall thickness > 3mm, and impacted gallstone on abdominal ultrasound were predictors of failure to achieve CVS. On multivariate analysis, neutrophil and lymphocyte percentages were independent predictors of failure to achieve CVS. Patients in whom CVS could not be achieved had significantly longer operative time, higher blood loss, complications, and hospital stays. Discussion Inability to achieve CVS during LC can be predicted preoperatively using various parameters including neutrophil and lymphocyte percentages. Such cases must be operated by senior surgeons or referred to experienced general or hepatobiliary surgeons for cholecystectomy to avoid bile duct injury. The proposed algorithm can help in intraoperative decision-making in difficult cases.

The gallbladder wall thickness in correlation with portal hemodynamic changes in cirrhotic patients

Background The gallbladder wall thickness (GBWT) is affected by portal hypertension, so GBWT can predict portal hemodynamic changes. Aim To determine whether noninflammatory GBWT correlates with portal hemodynamic changes and esophageal varices (EV) in cirrhotic patients. Patients and methods A total of 80 patients were enrolled in this cross-sectional study. Patients consisted of 30 cirrhotic patients with EV, 30 cirrhotic patients without EV, and 20 noncirrhotic individuals as a control group. Complete blood count, liver function tests, hepatitis C virus antibody, and HBsAg were assessed. Child–Pugh score was calculated in cirrhotic patients. Moreover, abdominal ultrasonography was performed for measuring wall thickness of the gallbladder, spleen length, and portal vein diameter. Moreover, portal vein Doppler was done for portal blood mean flow velocity measurement. Upper gastrointestinal tract endoscopy was done. Results GBWT was significantly increased in cirrhotic patients with EV compared with cirrhotic patients with without EV and noncirrhotic individuals (P&lt;0.001). Moreover, GBWT was significantly correlated with spleen length, portal vein diameter, and portal velocity in cirrhotic patients with EV (P&lt;0.001). Conclusion The GBWT could be one of the simple noninvasive predictors of portal hypertension and EV as it was positively correlated with portal hemodynamic changes that accompany cirrhotic portal hypertension.

Incidence of Port Site Infection After Laparoscopic Cholecystectomy: Our Experience at Hayatabad Medical Complex

OBJECTIVES This study aimed to assess the factors that affect post-laparoscopic cholecystectomies PSI and determine which characteristics can be changed to prevent PSI in a trial to maximize the benefits of laparoscopic surgery.METHODOLOGY The study included all patients who experienced port site infection following laparoscopic cholecystectomy. All patients received Inj Ceftriaxone 1gm pre-operatively &amp; then twice a day postoperatively for 03 days. In all operations, the gallbladder is removed from the epigastric port without using a retrieval bag by skilled surgeons employing four-port methods and reusable equipment. Most patients had the sub-hepatic tube drain placed and were discharged the day after surgery.RESULTSAcute cholecystitis was the most common operative finding with port-site infection, i.e. 6(42.8%), second being empyema that was seen in 3(21.4%) patients, 2(14.3%) patients had bad adhesions, mucocele in 2(14.3%) patients and thick walled gall bladder with stones was found in 1(7.1%) patients respectively, indicating that the relationship between infection and acute cholecystitis is significant. Regarding the spills of bile, stones, or pus, 3(21.4%) patients had infections despite there being no spillage, while 11(78.6%) patients developed an infection while the spillage happened during their procedures. The p-value was 0.0001, meaning that the spillage might be considered a risk factor for the development of port site infection.CONCLUSIONThe spilling of bile, stones, or pus, the port of gallbladder removal, and acute cholecystitis are all strongly associated with port site infection. Given that Mycobacterium tuberculosis may be the source of chronic deep surgical site infections, more care should be exercised. The majority of PSIs are superficial and more prevalent in men.

Associations of gallbladder and gallstone parameters with clinical outcomes in patients with cirrhosis.

Morphologic changes in the gallbladder and gallstones are common in cirrhotic patients, but their associations with outcomes of cirrhotic patients are unclear. We retrospectively enrolled 206 cirrhotic patients and measured their gallbladder length and width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width in axial contrast-enhanced computed tomography (CT) images. X-tile software was utilized to calculate the optimal cutoff values of these parameters for evaluating survival and hepatic decompensation events in the cirrhosis group. Their associations with survival were explored by Cox regression analyses and Kaplan-Meier curve analyses. Their associations with hepatic decompensation events were evaluated by competing risk analyses and Nelson-Aalen cumulative risk curve analyses where death was a competing event. Cirrhotic patients with gallbladder length < 72 mm had a significantly higher cumulative survival rate than those with a length of ≥ 72 mm (P = 0.049 by log-rank test), but gallbladder width, gallbladder wall thickness, presence of gallstones, and gallstones' length and width were not significantly associated with survival (P = 0.10, P = 0.14, P = 0.97, P = 0.73, and P = 0.73 by log-rank tests, respectively). Cirrhotic patients with gallbladder wall thickness < 3.4 mm had a significantly lower cumulative rate of hepatic decompensation events than those with a wall thickness of ≥ 3.4 mm (P = 0.02 by Gray's test), but gallbladder length and width, presence of gallstones, and gallstones' length and width were not significantly associated with hepatic decompensation events (P = 0.15, P = 0.15, P = 0.54, P = 0.76, and P = 0.54 by Gray's tests, respectively). Changes in gallbladder length and gallbladder wall thickness, rather than gallstone parameters, may be in parallel with the long-term outcomes of cirrhotic patients.

Sonographic gallbladder wall thickness measurement and the prediction of esophageal varices among cirrhotics.

Acute variceal bleeding in patients with liver cirrhosis and portal hypertension (PHT) is the most serious emergency complication among those patients and could have catastrophic ‎outcomes if not timely managed. ‎Early screening by esophago-gastro-duodenoscopy (EGD) for the presence of esophageal varices (EVs) is ‎‎currently recommended by the practice guidelines for all cirrhotic patients. Meanwhile, EGD is not readily accepted or preferred by many patients. The literature is rich in ‎studies to investigate and validate ‎ non-invasive markers of EVs prediction aiming at reducing the unneeded endoscopic procedures. Gallbladder (GB) wall thickness (GBWT) ‎measurement has been found promising in many published research ‎articles. We aim to highlight the validity of sonographic GBWT measurement in the ‎prediction of EVs based on the available evidence.‎ We searched databases including Cochrane library, PubMed, Web of Science and many others for relevant articles. GBWT is associated with the presence of EVs in cirrhotic patients with PHT of different etiologies. The cut-off of GBWT that can predict the presence of EVs varied in the literature and ranges from 3.1 mm to 4.35 mm with variable sensitivities of 46%-90.9% and lower cut-offs in viral cirrhosis compared to non-viral, however GBWT > 4 mm in many studies is associated with acceptable sensitivity up to 90%. Furthermore, a relation was also noticed with the degree of varices and portal hypertensive gastropathy. Among cirrhotics, GBWT > 3.5 mm predicts the presence of advanced (grade III-IV) EVs with a sensitivity of 45%, the sensitivity increased to 92% when a cut-off ≥ 3.95 mm was used in another cohort. Analysis of these results should carefully be revised in the context of ascites, hypoalbuminemia and other intrinsic GB diseases among cirrhotic patients. The sensitivity for prediction of EVs improved upon combining GBWT measurement with other non-invasive predictors, e.g., platelets/GBWT.

Multiparametric MR imaging with diffusion-weighted, intravoxel incoherent motion, diffusion tensor, and dynamic contrast-enhanced perfusion sequences to assess gallbladder wall thickening: a prospective study based on surgical histopathology.

To investigate the diagnostic performance of a multiparametric magnetic resonance imaging (MRI) protocol comprising quantitative MRI (diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), diffusion tensor imaging (DTI), and dynamic contrast-enhanced (DCE) perfusionMRI) and conventional MRI in the characterization of gallbladder wall thickening (GWT). This prospective study comprised consecutive adults with GWT who underwent multiparametric MRI between July 2020 and April 2022. Two radiologistsevaluated the MRI independently. The final diagnosis was based on surgical histopathology. The association of MRI parameters with malignant GWT was evaluated. The area under the curve (AUC) for the quantitative MRI parameters and diagnostic performance of conventional, and multiparametric MRI were compared. The interobserver agreementbetween two radiologists was calculated. Thirty-five patients (mean age, 56years, 23 females) with GWT (25 benign and ten malignant) were evaluated. The quantitative MRI parameters significantly associated with malignant GWT were apparent diffusion coefficient on DWI (p = 0.007) and mean diffusivity (MD) on DTI (p = 0.013), perfusion fraction (f) on IVIM (p = 0.033), time to peak enhancement (TTP, p = 0.008), and wash in rate (p = 0.049) on DCE-MRI. TTP had the highest AUC of 0.790, followed by MD (0.782) and f (0.742) (p = 0.213) for predicting malignant GWT. Multiparametric MRI had significantly higher sensitivity (90% vs. 80%, p = 0.045) than conventional MRI for diagnosing malignant GWT. The two radiologists' reading had substantial to near-perfect agreement (kappa = 0.639-1) and moderate to strong correlation (interclass correlation coefficient = 0.5-0.88). Multiparametric protocol incorporating advanced sequences improved the diagnostic performance of MRI for differentiating benign and malignant GWT. • Multiparametric MRI had 90% sensitivity and 88% specificity for diagnosing malignant GWT, compared to 80% sensitivity and 88% specificity for conventional CE-MRI. • Among the quantitative MRI parameters, TTP (perfusion-MRI) had the highest AUC of 0.790, followed by MD (0.782) and IVIM-f (0.742). • For most quantitative MRI parameters, there was moderate to strong agreement (ICC = 0.5-0.88).

Predicting difficulty in laparoscopic cholecystectomy preoperatively using modified Randhawa scoring system

Background: Laparoscopic cholecystectomy is a low-risk, minimally invasive operation and currently the standard for treatment of gallstone and gallbladder disease. Preoperative assessment of difficulty is required to prevent problems, ensure readiness, and ensure an effective course of surgery. Methods: In our work, we attempted to use a modified grading system developed by Randhawa et al. to preoperatively predict a difficult laparoscopic cholecystectomy. Age, gender, illness duration, history of prior GB disease, BMI, abdominal scar location (infra or supraumbilical), palpable gallbladder, and sonographic findings (gall bladder wall thickness, pericholecystic collection, and impacted stone) were assessed in patients who had been diagnosed with GB stones and required LC. Depending on the individual surgeon's assessment, a procedure is rated as easy, difficult, or very difficult. Results: On comparison of the test group difficulty level predicted with the gold standard of difficulty level intra op the test group has a sensitivity of 51.9 % and specificity of 100%. The test has a positive predictive value of 100% and Negative predictive value of 91.5%. The test and the gold standard agree on 154 out of 167 having a diagnostic accuracy of 92.21%. The Kappa value of 0.644 indicates very good agreement with a p value of &lt;0.001. Area under the curve indicates 96.1% of the difficulty is predicted by the Total score and significant with p value of &lt;0.001 Conclusions: The current modified Randhawa and Pujahari scoring method is useful and appropriate for forecasting operative outcome in laparoscopic cholecystectomy.

Wall thickness is an important predictor of gallbladder malignancy in patients surgically treated for gallbladder disease

Background: Gallbladder wall thickening is relatively common on imaging. GB thickening is a frequent finding caused by a spectrum of conditions. It is observed in many intracholecystic as well as intrinsic GB conditions. The study aimed to determine the relationship between the wall thickness of gallbladder malignancy in patients with gallbladder diseases. Methods: The Prospective cross-sectional and observational study was carried out in the department of general surgery and hepato-biliary-pancreatic surgery, BIRDEM general hospital, Dhaka from August 2019 to February 2021. Patients admitted to the general surgery and hepato-biliary-pancreatic surgery department of BIRDEM hospital who underwent gallbladder surgery were recruited for this study. Consecutive sampling was done in this study. Results: 86% of patients underwent laparoscopic cholecystectomy, while 14% had open cholecystectomy, of which 9 were simple and 6 were radical en block. The average wall thickness of the gallbladder was 7.5mm, with 52.7% moderate thickness, 37.3% mild, and 10% severe. 20% of patients with gallbladder disease had carcinoma, and the most common diagnosis was chronic calculous cholecystitis. A cut-off value of 8.25mm for gallbladder wall thickness had 81.8% sensitivity and 72.7% specificity in predicting carcinoma, and gallbladder wall thickness ≥8.25 mm had the highest significant odds ratio in predicting gallbladder carcinoma after adjusting for age, gender, and smoking history. Conclusions: GB carcinoma patients had significantly thicker gall bladder walls (9.80 vs 6.93 mm) and a higher frequency of severe GB wall thickness (36.36 vs. 3.41%) compared to patients without GB carcinoma. Gall bladder wall thickness is an important variable requiring consideration for the proper evaluation to exclude malignancy for undertaking proper surgical management, thus improving the long-term outcome.

Investigating the Relationship between Gallbladder Malignancy and Various Factors in Surgically Treated Gallbladder Disease Patients

Introduction: Gallbladder cancer is a rare but aggressive disease with a poor prognosis. Factors that may contribute to the development of gallbladder cancer include chronic inflammation, gallstones, and obesity. This study will examine the prevalence of these factors in patients who have undergone surgery for gallbladder disease, and determine if there is a correlation with the development of gallbladder cancer. This information will be valuable in identifying high-risk individuals and developing strategies for the early detection and prevention of gallbladder cancer. Methods: This prospective cross-sectional and observational study was carried out in the Department of General Surgery and Hepato-Biliary-Pancreatic surgery, BIRDEM General Hospital, Dhaka from August 2019 to February 2021. Patients admitted to the General Surgery and Hepato-Biliary-Pancreatic Surgery Department of BIRDEM hospital who underwent gallbladder surgery were recruited for this study. Consecutive sampling was done in this study. Result: The present study findings showed that the majority (65.45%) of the participants were between the age of 50-59 years, with 38.18% being male and 61.82% being female. The most common comorbidities were diabetes (62.73%), hypertension (43.64%) and anaemia (40%). The most common clinical presentation was abdominal pain (76.36%) and the most common histopathological diagnosis was chronic calculous cholecystitis (49.09%), while 20% of participants had gallbladder carcinoma. The study found an association between age, gallbladder wall thickness and gallbladder malignancy. Participants who were 60 years or older were 4.865 times more likely to have gallbladder carcinoma and those with severe wall thickness (&gt;10mm) were 13.32 times more likely to have gallbladder carcinoma. Conclusion: The present study found that the majority of participants were between the age of 50-59 years, with a higher female prevalence. The most common comorbidities were diabetes, ..........

Management of Acute Cholecystitis at Ouakam Military Hospital of Dakar, Senegal

Introduction: Acute lithiasis cholecystitis complicates 10 to 15% of symptomatic gallbladder stones. Emergency management with laparoscopic cholecystectomy within the first 72 hours treats the infection and the stones involved in one step without increasing morbidity or mortality. The aim of the study was to report our experience with laparoscopic treatment of acute lithiasis cholecystitis. Material and method: This is a descriptive retrospective study from January 2015 to December 2019. It include all patients treated urgently for acute lithiasis cholecystitis by laparoscopic route. Results: There were twenty-three (23) patients composed of 6 men and 17 women, ie a sex ratio of 3/1 in favor of women. The average age was 50.91 years (range 26 years and 85 years). One patient has sickle cell type SS. The duration of symptoms was 4 days on average (extreme 2 days and 7 days). The symptoms consisted of pain in the right hypochondrium (100%), fever, vomiting (30.4%), pain and localized defense in the right hypochondrium (82.6%). Hyperleukocytosis and elevated CRP were found in all patients. Biological cholestasis was noted in 1 patient. Ultrasound showed stones and a thickened gallbladder wall in 23 cases (100%), a Murphy's sign in 19 cases (82,6). Cholecystectomy was retrograde in 82.6% and anterograde 17.3% of cases. Conversion to laparotomy was performed in 4.3% (1 case). The intervention time was on average 59.6 min (range of 30 min and 180 min). The mean hospital stay was on average 3.6 days (range 2 and 13 days). No death was noted. Morbidity was 8.6%. Conclusion: The delay in consultation and the antibiotic therapy protocols lengthen the time taken for treatment. Laparoscopic cholecystectomy in the early forms can treat the inflammation and the stones involved in one step.

Gallbladder Beyond Gallstones

We describe imaging findings of the multiple entities that can cause gallbladder wall thickening. An algorithm for evaluation of gallbladder wall thickening also is presented.

Evaluation of Ultrasonography as an Adjunct for Diagnosis of Dengue Fever Among Children

Introduction: This study aims to evaluate the role of ultrasonography (USG) for early diagnosis of clinically suspected dengue fever before it becomes serologically positive and usefulness of USG in predicting severity of the disease. Methods: Prospective observational study conducted at a tertiary care hospital from April 2020 to March 2021, 70 cases of clinically suspected dengue within the age group of 6 months to 15 years presenting with fever for less than 5days underwent whole abdomen and chest ultrasonography. For seropositive cases, ultrasonography findings and their utility in early diagnosis and prediction of disease severity was analyzed along with their correlation to the clinical and laboratory profiles.Results:75.8% had primary dengue and 24.2% had secondary dengue. 94% cases demonstrated ultrasonography features suggestive of dengue like hepatomegaly (81%), ascites (63.8%), splenomegaly (56.9%), gall bladder wall thickness (46.6%), Cholecystitis (44.8%) and Pleural effusion (41.4%). Ascites and pleural effusion correlated well with clinical severity (p&lt;0.05). Ascites also had significant correlation with increased hematocrit (p=0.040) and thrombocytopenia (p=0). Significant correlation was observed between pleural effusion with decreased platelet count ((p=0.004) and decreased serum sodium levels (p=0.044). Gall bladder wall thickening &gt;5mm correlated well with disease severity. USG showed 94.3% sensitivity, 16.67% specificity and 81.43% of diagnostic accuracy in the seropositive cases of this study. Conclusion: Ultrasonography is useful not only as an adjuvant for early diagnosis of Dengue fever but also as a marker of disease severity.

Evaluation of Preoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is established as the gold standard for benign gallbladder disease. This study was done for the evaluation of preoperative scoring system given by Randhawa and Pujahari considering various preoperative parameters to predict difficulty in LC. Preoperative prediction of difficult LC using a scoring system considering various preoperative factors in elective/interval LC to predict difficult gallbladder. A prospective study of 120 patients admitted for LC from January 2020 to June 2021 was analyzed. All the patients were evaluated on the basis of Randhawa and Pujahari scoring system with the following variables: age >50 years, male sex, body mass index 25.1-27.5 and >27.5 kg/m2, previous abdominal surgery, prior hospitalization for gallstone disease, palpable gallbladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each variable had given a score. Based on these findings, the surgical procedure was defined as easy, difficult, and very difficult. One hundred and twenty cases satisfying the inclusion criteria were studied comparing different variables and assigned preoperative scoring. A score >5 was considered significant and compared with intraoperative findings. Out of 53 patients having preoperative scores >5, 40 were difficult gallbladders and 13 were easy to operate. Prediction came true in 93.0% of difficult cases and 83.1% of easy cases. From this study, we can conclude that the preoperative scoring system is statistically reliable to predict difficulty in LC in the majority of the cases (area under receiver operator characteristics = 0.935).

C-reactive Protein-to-Albumin Ratio Predicts Conversion from Laparoscopic to Open Cholecystectomy in Acute Cholecystitis.

The aim of this study was to identify predictors of conversion from laparoscopic to open cholecystectomy, and to determine whether pre-operative C-reactive protein-to-albumin ratio (CAR) can predict conversion from laparoscopic to open cholecystectomy, in patients with acute cholecystitis diagnosed according to the Tokyo Guidelines 2018. We retrospectively analysed 231 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 2012 and March 2022. Two hundred and fifteen (93.1%) patients were included in the laparoscopic cholecystectomy group; sixteen (6.9%) patients were included in the conversion from laparoscopic to open cholecystectomy group. In univariate analysis, significant predictors of conversion from laparoscopic to open cholecystectomy included the interval between symptom onset and surgery (>72 h), C-reactive protein (≥15.0 mg/l) and albumin (<3.5 mg/l) levels, pre-operative CAR (≥5.54), gallbladder wall thickness (≥5 mm), pericholecystic fluid collection, and pericholecystic fat hyperdensity. In multivariate analysis, elevated pre-operative CAR (≥5.54) and the interval between symptom onset and surgery (>72 h) were independent predictors of conversion from laparoscopic to open cholecystectomy. Pre-operative CAR as a predictor of conversion from laparoscopic to open cholecystectomy may be useful for pre-operative risk assessment and treatment planning.

Effects of laparoscopic and choledochoscopic gallbladder-preserving cholecystolithotomy on levels of operation indicators, gallbladder function, and cholecystokinin type-A receptor in patients with gallstones.

Gallstones are a common digestive system disease. To assess the effects of laparoscopic and choledochoscopic gallbladder-preserving cholecystolithotomy on the levels of operation indicators, gallbladder function, and cholecystokinin type-A receptor (CCKAR) in patients with gallstones. The medical records of 100 patients with gallstones receiving operation from July 2019 to August 2022 were collected for retrospective analysis. They were divided into a laparoscopic group (n = 48) and a laparoscopic + choledochoscopic group (n = 52). The laparoscopic group received totally laparoscopic cholecystolithotomy, while the laparoscopic + choledochoscopic group underwent laparoscopic and choledochoscopic cholecystolithotomy. Their perioperative indicators, gallbladder function, stress indicators (cortisol (Cor), norepinephrine (NE), and C-reactive protein (CRP)), serum biochemical indicators (liver receptor homologue 1 (LRH-1), CCKAR, and vasoactive intestinal peptide (VIP)), and complications were compared. The fasting gallbladder volume and gallbladder contraction rate increased, and the minimum residual volume and gallbladder wall thickness decreased in the laparoscopic + choledochoscopic group in comparison with those of the laparoscopic group 6 months after operation (p < 0.05). The levels of serum Cor, NE, CRP, and CCKAR were elevated, whereas the levels of serum LRH-1 and VIP were lowered in both groups 3 d after operation compared with those before operation (p < 0.05). The levels of serum Cor, NE, CRP, LRH-1, and VIP were lower, and the level of serum CCKAR was higher in the laparoscopic + choledochoscopic group than those in the laparoscopic group 3 d after operation (p < 0.05). Both laparoscopic gallbladder-preserving cholecystolithotomy and laparoscopic and choledochoscopic cholecystolithotomy are effective for treating gallstones. However, the latter combination method is superior in enhancing postoperative gallbladder function, decreasing the recurrence risk, regulating the expressions of LRH-1, CCKAR, and VIP, and promoting the postoperative recovery of gastrointestinal function.

AN OBSERVATIONAL STUDY ON PREDICTION OF DIFFICULTIES DURING LAPROSCOPIC CHOLECYSTECTOMY IN CASES OF CHOLELITHIASIS BY PREOPERATIVE ULTRASONOGRAPHY

BACKGROUND: Laparoscopic cholecystectomy has become the treatment of choice for cholelithiasis. Some reliable factors are needed to predict difficulties during laparoscopic cholecystectomy. So, our aim was to study various preoperative ultrasonographic parameters which may predict difficulties in performing laparoscopic cholecystectomy. METHOD: One twenty five patients of cholelithiasis admitted for elective laparoscopic cholecystectomy were studied. Preoperative ultrasonographic parameters such as gall bladder(GB) wall thickness, transverse diameter of GB, pericholecystic fluid collection, gall stone mobility, number of stones & size of largest stone, common bile duct(CBD) diameter and emphysematous cholecystitis were given a score of 0 or 1 based on findings being negative or positive respectively. Total score was correlated with the difficulties faced during laparoscopic cholecystectomy. RESULT: Out of 125 cases, 42(33.6%) cases were found to be difficult during laparoscopic cholecystectomy and 6 cases (4.8%) required conversion to open cholecystectomy. GB wall thickness (p value= 0.00001), transverse diameter of GB (p value= 0.001), pericholecystic fluid collection (p value= 0.00001), dilated CBD (p value=0.007), size of stone (p value= 0.007) found to be statistically significant in predicting difficulties during laparoscopic cholecystectomy. Higher the preoperative USG score, higher were the chances of difficult laparoscopic cholecystectomy and conversion to open cholecystectomy. CONCLUSION: Pre operative ultrasonography in the form of a formulated score is a good predictor of difficulties during laparoscopic cholecystectomy.