Clinical presentation and surgical outcome among patients having single and multiple gallstones: a prospective study
Keywords:Multiple gallstones, Difficult laparoscopic cholecystectomy, Clinic-radiological factors, Gallstones, Cholecystectomy
Background: Outcome of laparoscopic cholecystectomy is determined by an array of factors including patient & gallstone-related variables. Number of gallstones influences pathophysiology of disease thereby influencing outcome of surgery. This study was aimed at investigating clinical, haematological, radiological features and surgical outcomes among patients having single and multiple gallstones.
Methods: Single centre, hospital-based, prospective, observational study involving 60 patients undergoing LC. Data pertaining to clinical, hematological, radiological variables and surgical outcomes were collected and analysed.
Results: Mean duration of symptoms (m/c- pain) was significantly shorter among participants having multiple gallstones (p=0.034). There was no statistically significant difference among participants having single and multiple stones regarding any of clinical signs and symptoms (p>0.05). Mean GB wall thickness among patients having single and multiple gallstones was 3.27 mm and 4.18 mm (p=0.038). Difference in proportion of patients having pericholecystic collections was statistically significant (p=0.019). Mean duration of surgery among participants with single and multiple stones was 57 minutes and 71 minutes, respectively (p=0.012). On intraoperative examination, adhesion was noted in 20% of participants with single stone and 35% of participants in multiple stones group (p=0.029). Conversion rate to OC was 12% in multiple stones group and only 3.4% of participants with single stone (p=0.028). Adjusted odds ratio for conversion to OC was 3.39 (95% CI 1.98-7.89) for patients having multiple gallstones.
Conclusions: Although patients having single and multiple gallstones have similar clinical features, findings of ultrasonography and surgical outcomes may differ significantly.
Comitalo JB. Laparoscopic cholecystectomy and newer techniques of gallbladder removal. J Soc Laparoendosc Surg. 2012;16(3):406.
Laparoscopic Cholecystectomy: What has changed Over the Last Three Decades? ; Available at: http://clinicsinsurgery.com/. Accessed on 20 October 2021.
Sarli L. Mini-laparoscopic cholecystectomy vs laparoscopic cholecystectomy. Surg Endosc. 2001; 15(6):614-8.
Fursov AB, Ismailov AS, Kuspaev EN. Disadvantages and complications of laparoscopic operations. FASEB J. 2015;29(S1):LB685.
Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, et al. Mortality and complications associated with laparoscopic cholecystectomy. A meta-analysis. Ann Surg. 1996;224(5):609.
Galizia G, Prizio G, Lieto E, Castellano P, Pelosio L, Imperatore V, et al. Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum and abdominal wall-lifting cholecystectomy. A prospective, randomized study. Surg Endosc. 2001;15(5):477-83.
Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecy-stectomy. Surg Endosc. 2005;19(7):905-9.
Philip Rothman J, Burcharth J, Pommergaard HC, Viereck S, Rosenberg J. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery-a systematic review and meta-analysis of observational studies. Dig Surg. 2016;33(5):414-23.
Verma GR, Bose SM, Wig JD. Pericholecystic Adhesions in single v multiple gallstones and their consequences for laparoscopic cholecystectomy. Dig Surg. 2001;11(5).
Carey MC. Pathogenesis of gallstones. Am J Surg. 1993;165(4):410-9.
Reshetnyak VI. Concept of the pathogenesis and treatment of cholelithiasis. World J Hepatol. 2012; 4(2):18.
Mofti AB, Engl F, Al-momen A. The single gallbladder stone is it innocent ? 1994;14(6):471-3.
Misrani JK, Iqbal S, Sasoli NA, Memon ZA, Ahmedani SA. Comparative study of clinical profile in patients with solitary versus multiple gall stone. J Liaquat Univ Med Heal Sci. 2016;15(1):12-5.
Jalali SA, Jalali SM. Statistical comparison, clinical presentation and prognosis of single and multiple- stones, choloelithiasis. Razi J Med Sci. 2001;7(22): 253-6.
Raja CDK, Keerthi D, Sai A, Aravind G, Raja S, Karthik GM, et al. Comparative study of single versus multiple gallstone disease in KGH , Visakhapatnam. 2020;7(10):3370-3.
Sharma D, Kishore KN, Gondu GR, Thumma VM, Gunturi SV, Reddy JM, et al. Predictive factors for conversion from laparoscopic to open cholecystectomy: an institutional study. Int Surg J. 2018;5(8):2894.
Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: A scoring method. Indian J Surg. 2009;71(4):198-201.
Kirkwood BR, Sterne JAC, Kirkwood BR. Essential medical statistics. 2003;501.
Berkson J. Tests of significance considered as evidence. J Am Stat Assoc. 1942;37(219):325-35.
Lammert F, Dumoulin FL, Sauerbruch T. Gallstone Disease. Textb Hepatol Basic Sci to Clin Pract. 2008;5:1518-40.
Raftery AT. Regeneration of peritoneum: a fibrinolytic study. J Anat. 1979;129(3):659.
Vracko J, Wiechel K-L. The laparoscopic finding of pericholedochitis at cholecystectomy predicts the presence of unsuspected bile duct stones. Surg Laparosc Endosc Percutan Tech. 2000;10(3):120-6.
Frierson HF. The gross anatomy and histology of the gallbladder, extrahepatic bile ducts, Vaterian system, and minor papilla. Am J Surg Pathol. 1989;13(2): 146-62.