Cholelithiasis: causative factors, clinical manifestations and management
Abstract
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.
Keywords
Full Text:
PDFReferences
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.