Cholelithiasis: causative factors, clinical manifestations and management

Renu Pimpale, Pradeep Katakwar, Murtaza Akhtar


Background: Cholelithiasis is a common gastrointestinal disorder with an overall prevalence of 2-29%. This study aims to evaluate the evolution of demographic and etiological factors, the clinical manifestations of Cholelithiasis, the surgical management with its post-operative complications and the histopathological findings of the post-cholecystectomy specimen of gallbladder, in central India.

Methods: Patients symptomatic or asymptomatic diagnosed ultrasonically as cholelithiasis were included in the study and patients with primary choledocholithiasis were excluded.

Results: A total of 92 patients were enrolled, of which 62 (68.89%) were female, with mean age of 45.03yrs ± 13.59. Fifty four patients (58.69%) were having BMI >25. Pain was most common complaint seen in all patients. Jaundice was observed in 13 patients (14.13%) who had associated CBD calculus. Sickling was positive in 8.69% of patients. Lap cholecystectomy was done in 71 (77.17%) patients with a conversion rate of 6.57%. Nineteen (20.65%) were open cholecystectomy with or without CBD exploration and 2 underwent Lap cholecystostomy. Post operatively, surgical site infection was seen in 3 patients (4.22%) of laparoscopic cholecystectomy, 5 patients (26.31%) of open cholecystectomy and biliary leak was seen in 3 patients (15.78%) of open cholecystectomy. Histopathology of gallbladder was chronic cholecystitis in 70 patients (77.77%), malignancy was detected in 5 patients (5.55%) and Xanthogranulomatous cholecystitis in 2 patients (2.22%).

Conclusions: Cholelithiasis is commonly seen in females in 4th and 5th decade mainly presenting with abdominal pain and dyspepsia. Laparoscopic cholecystectomy offers best surgical management with lesser complications.


Cholecystectomy, Cholelithiasis, Gallstones, Laparoscopy

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Johnston DE, Kaplan MM. Pathogenesis and Treatment of Gallstones. N Engl J Med. 1993;328(6):412-21.

Haribhakti SP, Mistry JH. Techniques of laparoscopic cholecystectomy: Nomenclature and selection. J Minim Access Surg. 2015;11(2):113–8.

Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. Hpb. 2011;13(2):117–25.

Tendon R. Diseases of gallbladder and biliary tract-API Textbook of Medicine. 7th ed. Shah DSN, editor. 2003;642-4.

Bhatti A, Waqar A, Zia S, Hussain N, Zulfiqar T. A cross sectional study on the risk factors of gallbladder stone. Int J Res Med Sci. 2016;4(11):5041–6.

Muthalaisamy DP, Rajachidambaram DK, Karthick DP. Clinicopathological evaluation of cholelithiasis and management strategies at a tertiary care hospital. Glob J Res Anal. 2018;6(12): 90-4.

VP S, Tank P, Singh A, Goel S, Nathwani P. A study of gall stone disease from a tertiary care center of Madhya Pradesh, India. Int Surg J. 2017;4(2):728.

Selvi RT, Sinha P, Subramaniam PM, Konapur PG, Prabha C V. a Clinicopathological Study of Cholecystitis With Special Reference To Anal Ysis of Cholelithiasis. Int J Basic Med Sci. 2011;2:68–72.

Kamil Khalaf S, Al Mousawi JH. Prevalence and Risk Factors of Asymptomatic Gallstones in a Sample of Population in Basrah, Iraq. Arch Med. 2016;8(4):1–6.

Gyedu A, Adae-Aboagye K, Badu-Peprah A. Prevalence of cholelithiasis among persons undergoing abdominal ultrasound at the Komfo Anokye Teaching Hospital, Kumasi, Ghana. Afr Health Sci. 2015;15(1):246–52.

Cirillo DJ, Wallace RB, Rodabough RJ, Greenland P, LaCroix AZ, Limacher MC, et al. Effect of Estrogen Therapy on Gallbladder Disease. JAMA. 2005;293(3):330.

Muflih Alghaythi S, Hathloul Alshammri J, Taiwilaa Alshammari F, Nashi Alshammari F, Yousef Al-Muzaini A, Sultan Turki Alsudayri M, et al. Prevalence and Risk Factors for Gallstone Disease in Hail Region. Egypt J Hosp Med. 2018;70(4):703-5.

Sun H, Tang H, Jiang S, Zeng L, Chen E-Q, Zhou T-Y, et al. Gender and metabolic differences of gallstone diseases. World J Gastroenterol [Internet]. 2009;15(15):1886–91.

Talseth A, Ness-Jensen E, Edna T-H, Hveem K. Risk factors for requiring cholecystectomy for gallstone disease in a prospective population-based cohort study. Br J Surg. 2016;103(10):1350–7.

Stender S, Nordestgaard BG, Tybjaerg-Hansen A. Elevated body mass index as a causal risk factor for symptomatic gallstone disease: A Mendelian randomization study. Hepatol. 2013;58(6):2133–41.

Shabanzadeh DM, Sørensen LT, Jørgensen T. Determinants for clinical events in gallstone carriers unaware of their gallstones. J Gastroenterol Hepatol. 2017;32(3):721-6.

McConnell TJ, Appleby PN, Key TJ. Vegetarian diet as a risk factor for symptomatic gallstone disease. Eur J Clin Nutr. 2017;71(6):731–5.

Kumar Verma S, Das R, Gaurav K. Epidemiology and management of gall stone disease in tribal population of eastern India. IJIRR. 2016;3(12):3361-3.

Lokesh K, Siddavaram S. A Clinical study of gall stone disease. Orig Res Artic J Evid Based Med Heal. 2017;4(94):5789-97.

Jai Kumar Misrani, Sadaf Iqbal, Nazir Ahmed Sasoli ZAM, Ahmedani SA. Comparative Study of Clinical Profile in Patients with Solitary versus Multiple Gall Stone. J Liaquat Uni Med Health Sci. 2016;15(1):12-5.

Rao KS, Ravi K. A Prospective Study on Cholelithiasis and Its Complications. IOSR J Dent Med Sci. 2017;16:1-04.

Martins RA, Soares RS, Vito FB De, Barbosa V de F, Silva SS, Moraes-Souza H, et al. Cholelithiasis and its complications in sickle cell disease in a university hospital. Rev Bras Hematol Hemoter. 2017;39(1):28–31.

Gumiero AP dos S, Bellomo-Brandão MA, Costa-Pinto EAL da. Gallstones in children with sickle cell disease followed up at a Brazilian hematology center. Arq Gastroenterol. 2018;45(4):313–8.

Rachamalla RR, Markapuram KK, Satish S. A one-year study of cholelithiasis at a tertiary care hospital of South India. Int Surg J. 2018;5(7):2444.

Atmaram DC, Lakshman K. Predictive factors for conversion of laparoscopic cholecystectomy. Indian J Surg. 2011;73(6):423–6.

Csikesz N, Ricciardi R, Tseng JF, Shah SA. Current Status of Surgical Management of Acute Cholecystitis in the United States. World J Surg. 2008;32(10):2230–6.

Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O. Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery: A New Predictive Statistical Model. J Laparoendosc Adv Surg Tech. 2016;26(9):693–6.

Barase AK. A study of laparoscopic cholecystectomy in rural setup. Int Surg J. 2018;5(9):3111–7.