Evaluation of relationship of body mass index with severity of cholecystitis

Background: Obesity is an established risk factor for gall stone disease. Male sex has also been recently cited as a risk factor for severe symptomatic cholelithiasis. As a possible cause of several difference in regards to the severity of cholecystitis, many physiological differences between the two sexes can be examined. Many studies have been done on the risk factors for developing the gall bladder disease explaining its polygenic nature It is postulated that the total body fat, the main value of which is significantly higher for females than males, may contribute to this sex difference. Only a couple of studies are available on BMI and its effect on severity of cholecystitis hence depicting the need for this study in our setup.Methods: This is a prospective study carried out on 70 patients for cholecystitis whose weight and height measurements had been recorded on admission. Patients were placed in either group-Obese (BMI e” 25kg/m2) or Non-Obese (BMI <25kg/m2). The association between BMI and severity of cholecystitis was investigated.Results: 18% of the laparoscopic cholecystectomy surgeries required conversion to open cholecystectomy due to reasons like severe adhesions to an adjacent organ, etc. Pain in abdomen (100%) was the commonest complaint and was present in all the patients followed by dyspepsia (44%).69% of patients were having complaints for more than 72 hours. No significant difference observed among mean BMI of different grades of severity (p=0.963).Conclusions: There is negative correlation between BMI and grade of severity of cholecystitis and BMI is not a predictor for the conversion from laparoscopic to open cholecystectomy.

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A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively

International Surgery Journal ◽

10.18203/2349-2902.isj20173878 ◽

2017 ◽

Vol 4 (9) ◽

pp. 3015

Author(s):

Arun Prasath S. ◽

Surag Kajoor Rathnakar ◽

Nagaraja Anekal L.

Keyword(s):

Laparoscopic Cholecystectomy ◽

Abdominal Surgery ◽

Open Cholecystectomy ◽

Fluid Collection ◽

Gall Stone ◽

Stone Disease ◽

Elderly Age ◽

Conversion To Open Cholecystectomy ◽

Upper Abdominal ◽

A Prospective Study

Background: Laparoscopic cholecystectomy considered as the gold standard treatment for symptomatic gall stone disease has 1-13% conversion rate to an open procedure due to various reasons. Present study aims to predict difficult laparoscopic cholecystectomy preoperatively using clinical and sonological factors.Methods: This is a prospective study done on 190 patients who were posted for laparoscopic cholecystectomy from March 2015 to February 2017. Parameters taken into consideration were: age, number of previous attacks of acute cholecystitis, impacted gallstone, thickness of GB wall, pericholecystic fluid collection, history of upper abdominal surgery and obesity. All surgeries were performed by surgeons with minimum ten years of experience on laparoscopic cholecystectomy and ultrasound of the abdomen was performed by senior radiologists with experience of minimum five years.Results: Out of 190 patients, difficulty was experienced in 48 patients of which conversion to open cholecystectomy was needed for 11 patients. Elderly age, multiple attacks of pain abdomen (>2), palpable GB, impacted gallstone, thickness of GB wall >3 mm, peri-GB fluid collection, adhesions due to previous abdominal surgery and obesity were all found to be independent risk factors leading to difficult laparoscopic cholecystectomy.Conclusions: Though there is no definite scoring system to predict difficult LC, there is scope for further refinement to make the same less cumbersome and easier to handle using the above clinical and radiological factors.

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Prospective randomised trial of standard pressure versus low pressure laparoscopic cholecystectomy in a tertiary care hospital from Kolkata: Our experience

Asian Journal of Medical Sciences ◽

10.3126/ajms.v9i4.19780 ◽

2018 ◽

Vol 9 (4) ◽

pp. 17-22

Author(s):

Bikash Chandra Ghosh ◽

Ambar Gangopadhyay

Keyword(s):

Laparoscopic Cholecystectomy ◽

Laparoscopic Surgery ◽

Gall Stone ◽

Low Pressure ◽

Stone Disease ◽

Care Hospital ◽

Significant Difference ◽

Gall Stone Disease ◽

Standard Pressure ◽

Symptomatic Gall Stone

Background: Laparoscopic cholecystectomy (LC), the procedure of choice for symptomatic gall stone disease. An emerging trend is to perform Low pressure pnuemoperitonium laparoscopic surgery as it has additive advantages over standard pressure to avoid complications while providing adequate working space.Aims and Objectives: The current study was designed with an aim to compare the advantage of low pressure pneumoperitoneum vs standard pressure pneumoperitoneum in laparoscopic cholecystectomy.Materials and Methods: The study was conducted in the department of General Surgery in R.G.Kar Medical College from January 2014 to June 2015. A total of 52 patients with symptomatic gall stone disease were recruited, 26 patients in each group randomly. Some intraoperative and post-operative parameters were studied.Results: All the intra-operative (IO) cardio-respiratory parameters (Pulse, Mean Arterial Pressure (MAP), End tidal CO2, spO2) were recorded just before incision, 20 minutes intra-operatively and before reversal of general anesthesia (GA). The IO parameters in our study, were found to be significant only at 20 minutes IO and before reversal of GA. The post-operative (PO) parameters (Pulse, MAP, Respiratory rate, spO2) and pain by VAS score at 6 hours, 12 hours and 24 hours post-operatively were studied. In PO period, we observed significant differences at 2 hours post-operatively in all parameters except MAP. There was significant difference in pain at 6, 12 and 24 hours when compared in both groups. The shoulder tip pain (STP) and 2 hours PO nausea and vomiting were found to be significantly higher in Standard pressure Laparoscopic cholecystectomy (SPLC) compared to Low pressure Laparoscopic cholecystectomy (LPLC). The operative time, duration of hospital stay and return to normal life after surgery though had differences but it was statisticallyinsignificant.Conclusion: Low pressure laparoscopic surgery is safe with least post operative complications when performed by experienced surgeons even in patients of ASA III.Asian Journal of Medical Sciences Vol.9(4) 2018 17-22

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Prevalence of Sub-Clinical Hypothyroidism in Diagnosed Cases of Gallstone Disease

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i41a32319 ◽

2021 ◽

pp. 207-212

Author(s):

C. Kamalakkhannan

Keyword(s):

Gallstone Disease ◽

Gall Stone ◽

Clinical History ◽

Gallstone Formation ◽

Stone Disease ◽

Thyroid Function Tests ◽

Age Group ◽

Medical College ◽

Gall Stone Disease ◽

A Prospective Study

Thyroid issues have long been debated as a possible cause of gall stone disease. The link between hypothyroidism and gallstone disease could be explained in a variety of ways. The main objective of this study is to determine the prevalence of hypothyroidism in gallstone patients and to rule out hypothyroidism as a probable cause of gallstone formation. A prospective study was conducted in surgical wards of Department of surgery sree balaji medical college from 2016 to 2017. All patients were evaluated using a comprehensive clinical history and examination, as well as suitable investigations such as abdominal USG, thyroid function tests, and lipid profiles. Out of 22 patients 19 patients (86.4%) had normal TSH, 2 patients (9.1%) had increased TSH, 1 patient (4.5%) had decreased TSH. Raised TSH was more in the AGE Group of 61- 75 years, which is comparable to other studies. Out of 22 patients, (100%) had normal T3 levels. 19 patients (86.4%) had normal T4 levels and Ultrasound examination of neck, 2 patients (9.1%) had decreased T4 level and 1 patient (4.5%) had increased T4 levels and 3 patients (13.6%) had abnormal Ultrasound Neck findings. Hence In this Study Cholelithiasis is most commonly seen in Females of age group of 41-60 years and prevalence of raised TSH level in cholelithiasis patient was 9% and most were found in the age group of 61-80 years.

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A study on laparoscopic cholecystectomy, indications, complications and conversion to open in a tertiary care hospital

International Surgery Journal ◽

10.18203/2349-2902.isj20195100 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3942

Author(s):

N. Chandramouli

Keyword(s):

Laparoscopic Cholecystectomy ◽

Tertiary Care ◽

Gall Stone ◽

Stone Disease ◽

Care Hospital ◽

Open Conversion ◽

Calot’S Triangle ◽

Institutional Ethics ◽

Gall Stone Disease ◽

A Prospective Study

Background: Disease of gall bladder, especially the stones, is one of the most common health problems leading to surgical intervention. Laparoscopic cholecystectomy is the gold standard operation for gall stone disease with a good safety profile. The aim of the study was to discuss the indications, complications encountered and open conversion rate of laparoscopic cholecystectomy in a tertiary care hospital.Methods: It was a prospective study, conducted at Sri Adichunchanagiri Hospital and Research Center, B.G. Nagara, Karnataka after the approval from institutional ethics committee (IEC). This study included 30 patients who presented to the ER or OPD with pain abdomen, from October 2018 to March 2019, and diagnosed to have gall stone disease with or without inflammation. All the patients were worked up as per standard institutional protocol. Patients clinical characteristics, ultrasonogram (USG) findings, surgical management and complications were recorded.Results: Mean age was 41.1±6.06. The indications for cholecystectomy in gall stone disease at our institute during the aforementioned timeline were symptomatic gall stones (60%) and calculus cholecystitis (40%). All underwent laparoscopy and 2 patients were converted to open surgery intra-operatively in view of difficulty in dissection of Calot’s triangle. 3 patients had post-operative complications and treated conservatively.Conclusions: Laparoscopic cholecystectomy is a standardised, efficacious procedure for the treatment of gall stone disease whether symptomatic or infected. Complications are minimal but a thorough knowledge of open procedure is also essential in case of intra-operative conversion.

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Can Laparoscopic Cholecystectomy be a Feasible Standard in a Rural set up too? - An Experience of 348 cases from a Peripheral set up of Western Nepal

Kathmandu University Medical Journal ◽

10.3126/kumj.v13i2.16785 ◽

2017 ◽

Vol 13 (2) ◽

pp. 130-133

Author(s):

A.L. Shrestha ◽

P. Shrestha ◽

D. Brown

Keyword(s):

Socioeconomic Status ◽

Laparoscopic Cholecystectomy ◽

Rural Population ◽

Gall Stone ◽

Stone Disease ◽

Uneventful Recovery ◽

Conversion To Open Cholecystectomy ◽

Gall Stone Disease ◽

Set Up ◽

The Impact

Background Gall stone disease is a common reason for admissions in both acute and elective situations and bears significant morbidity in the rural population of western Nepal. The earlier conventional open method of treatment for the same seems to have been largely seeded by the laparoscopic approach owing to its numerous benefits.Objective To study the clinical profile of patients with symptomatic gall stones with respect to demography and to assess the feasibility of using Laparoscopic cholecystectomy as the next standard in this set up too as guided by the outcome in terms of complications, conversion rates and potential impact it bears on the health and socioeconomic status in this group.Method A retrospective analysis of all the patients undergoing an attempted laparoscopic cholecystectomy from 1st Jestha 2068 to 30th Jestha 2070 was done. Relevant medical records were reviewed to study demography, various indications for operations, intra operative events including conversions and complications.Result Of 348 patients 293(84.19%) were females and 55(15.80%) were males. The mean age was 38.46 years (range 15-76 years). Most of the patients belonged to the Palpa district of Lumbini zone and many were from other surrounding areas. Gall stone disease was commonest in people of Brahmin ethnicity. The operating time was <2 hours for most and most had an uneventful recovery with a mean hospital stay of 3.8 days. The rate of conversion to open cholecystectomy was 6.9% (24 out of 348 patients). Post operative complications were noted in 5 patients (1.42%). Of these 1 sustained a major bile duct injury (0.28%) requiring immediate conversion and repair, 3 had post operative bilioma and 1 had diffuse bleeding from the gall bladder fossa all requiring re explorations. There was no mortality in this study.Conclusion Laparoscopic cholecystectomy is a safe, reliable and a promising option even in the rural peripheral set up. Due to its well known advantages and superiority over the open conventional method and considering the impact that it holds on the overall outcome, morbidity, health and socioeconomic status of the rural population, it can be recommended as an acceptable feasible standard in rural peripheral set up.

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LAPAROSCOPIC SURGERY;

The Professional Medical Journal ◽

10.29309/tpmj/2014.21.03.2138 ◽

2014 ◽

Vol 21 (03) ◽

pp. 529-534

Author(s):

Umar Fayyaz Ghani ◽

Faran Khan ◽

Ameer Yasser Zaid ◽

Khan Dost Afridi

Keyword(s):

Gall Stone ◽

Bile Leakage ◽

Stone Disease ◽

Safe Procedure ◽

Conversion To Open Surgery ◽

Iatrogenic Perforation ◽

Gall Stones ◽

Study Results ◽

Gall Stone Disease ◽

A Prospective Study

Objective: To observe the rate of complications during elective laparoscopiccholecystectomies. Design and study duration: It was a prospective study and was carried outfrom July 2011 to June 2012. Setting: The study was conducted at PAF Hospital Islamabad.Patients: 105 patients with gall stone disease who underwent elective laparoscopiccholecystectomy. Material and Methods: 105 patients ranging in age from 23yrs to 81yrs wereoperated. 12 were males and 93 were females. History, clinical examination and ultrasonographywere used to diagnose the presence of gall stones. Patients with acute symptoms were excludedfrom the study. Results: The main complications encountered were iatrogenic perforation of thegall bladder (8), haemorrhage (7), post-operative bile leakage (4), and large gut injury (1).Conversion to open surgery was done in three cases due to difficulty in identifying anatomy and incase of large gut injury. There was one death. Conclusions: Laparoscopic cholecystectomy (LC)has become the preferred method of treatment in surgery for gall stone disease. A soundknowledge of the complications and their management makes this a safe procedure.

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Diagnosis of Helicobacter pylori in cholelithiasis and cholecystitis: by histology and serological association

International Surgery Journal ◽

10.18203/2349-2902.isj20195110 ◽

2019 ◽

Vol 6 (11) ◽

pp. 3986

Author(s):

Srinivasan Doraiswamy ◽

Dharmendra Kumar ◽

P. N. Sreeramulu ◽

Suresh .

Keyword(s):

Helicobacter Pylori ◽

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

Marked Rise ◽

Female Ratio ◽

Gall Stone Disease ◽

Calculus Disease ◽

Set Up ◽

Calculous Cholecystitis

Background: Biliary calculus disease is one of the most common disorders affecting the gastrointestinal tract. It is an important cause of morbidity. There has been marked rise in the incidence of gall stone disease in the west. In India, it is more common in northern states than in South India. Incidence of gallstones increases with age with a male to female ratio of 1:4. About 50% of these patients are asymptomatic.Methods: An analytical prospective study on patients diagnosed with cholecystitis and/or cholelithiasis was conducted in R. L. Jalappa Hospital Tamaka, Kolar. 58 patients were included in the study between June 2018 and May 2019. Data was collected and analysed using SPSS 22 version software. Categorical data was represented in the form of frequencies and proportions.Results: The age incidence was found to be highest between 31 to 40 years. The incidence of cholelithiasis was more in females. All patients presented with pain abdomen. Calculous cholecystitis was the most common mode of presentation. Open cholecystectomy was commonly done for cholelithiasis in our set up. Chronic calculous cholecystitis is the commonest histopathology.Conclusions: According to our findings evidence of recent and chronic infection Helicobacter pylori as shown by demonstration of IgM and IgG class of antibodies respectively to the organism was found in most of patients and histological evidence of the patients with cholecystitis and cholelithiasis. Thus, the frequency of helicobacter infection seems to be low in the patient population studied.

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Is hypothyroidism a risk for gall stone disease? a study to assess the association

International Surgery Journal ◽

10.18203/2349-2902.isj20173406 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2665

Author(s):

Yawar Zahoor Watali ◽

Rahul Jain ◽

Rajandeep Singh Bali ◽

Ankul Mittal

Keyword(s):

Gall Stone ◽

Stone Disease ◽

Control Group ◽

P Value ◽

Case Group ◽

Endocrine Disorders ◽

Gall Stones ◽

Significant Difference ◽

Gall Stone Disease ◽

Thyroid Profile

Background: Gall stones are one of the most common problems affecting the digestive tract requiring hospitalization. The disease frequently occurs in young, otherwise healthy people with a prevalence of 11-36 % on autopsy report. Thyroid diseases are, arguably, among the commonest endocrine disorders worldwide. In the present study, we have tried to determine an association between gall stone disease, and previously diagnosed and undiagnosed hypothyroidism in patients presenting to our hospital for treatment. The aim of this study was to determine association between gallstones and hypothyroidism and to study the prevalence of previously undiagnosed hypothyroidism in all patients of gallstones.Methods: The study was a hospital based cross sectional, observational study conducted on 200 patients with upper abdominal pain attending the Surgery OPD and Emergency over a period of 1 years. Patients were divided into 2 groups: Case group (100 patients) with gall stones on ultrasound and Control group (100 patients) without gall stones on ultrasound. Thyroid profile along with other biochemical investigations was done and both the groups were compared for the parameters.Results: Both groups were comparable for age and sex of the patients. On considering the thyroid profile of the patients in both the groups we observed that 14% of patients were hypothyroid in case group and 8% of the patients in control group. On comparing the two groups, there was no statistically significant difference in the prevalence of hypothyroidism (p value 0.175) between the two groups. There was a significant difference when serum cholesterol and bilirubin levels were compared between the two groups. 7 patients out of 100 cholelithiasis had Choledocolithiasis too, these patients had significantly raised cholesterol and deranged liver function tests.Conclusions: No significant relation between gallstones and hypothyroidism was found in this study (p value=0.175) and need further evaluation. Among the hypothyroid patients the incidence of gall stones was highest among 51-60 years of age so we recommend that TSH level should be measured for every patient with gallstone disease in this age range.

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The ideal timing of cholecystectomy for mild gallstone pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20195980 ◽

2019 ◽

Vol 7 (1) ◽

pp. 253

Author(s):

Satishkumar R. ◽

Anukethan J.

Keyword(s):

Hospital Stay ◽

Open Cholecystectomy ◽

Gallstone Disease ◽

Gall Stone ◽

Gallstone Pancreatitis ◽

Readmission Rates ◽

Duration Of Hospital Stay ◽

Significant Difference ◽

Conversion To Open Cholecystectomy ◽

The Ideal

Background: Gallstone disease is one of the most common problems affecting the digestive tract with a prevalence of 11% to 36% and is the most common cause of gall stone pancreatitis. The cholecystectomy is necessary to prevent recurrent pancreatitis in gallstone pancreatitis, but the ideal timing for cholecystectomy is controversial.Methods: This was a prospective randomized study with 59 patients conducted in the department of general surgery, KIMS, Bangalore from 2014 to 2019. All patient with mild gallstone pancreatitis, the following variables, duration and cost of hospital stay, readmission rates, intraoperative time, intra and postoperative complications and conversion to open cholecystectomy were studied.Results: A total of 59 patients in the age group of 21 to 71 years with mild gallstone pancreatitis were included in the study. Mean age of presentation was 57years. Out of 59 patients 28 underwent same admission cholecystectomy and 31 underwent interval cholecystectomy. There was a significant difference noted in terms of mean duration of hospital stay (9.28 versus 17.20 days), mean cost of hospital stay (19340 versus 28240rs) and readmission rate (0% versus 19.35%), but in terms of mean intraoperative time (85 min versus 92 min) and conversion rate (0% versus 6.4%) there was no statistically significant difference between two group.Conclusions: Same admission cholecystectomy for mild gallstone pancreatitis can significantly reduce cost and duration of hospital stay and readmission rates. With regard to intraoperative time, conversion to open, intraoperative and postoperative complication there is no statistically significant difference seen. Hence same admission cholecystectomy is safe, feasible and recommended.

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Evaluation of patients undergoing cholecystectomy with special reference to post-cholecystectomy syndrome

International Surgery Journal ◽

10.18203/2349-2902.isj20182245 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2313

Author(s):

P. S. Khatana ◽

Jitendra Kumar ◽

Deepak Kumar Sharma

Keyword(s):

Open Cholecystectomy ◽

Gall Stone ◽

Stone Disease ◽

New Delhi ◽

Biliary Disease ◽

Medical College ◽

Number Of Patients ◽

Gall Stone Disease ◽

The Mean ◽

Age Range

Background: Significant percentage of patients remain symptomatic even after the cholecystectomy surgery for gall stone disease. Traditionally, this has been termed Post-Cholecystectomy syndrome which may consist of same symptoms for which cholecystectomy was performed or it may be a new set of symptoms that have developed after cholecystectomy. Aim of this study to find out incidence as well as pre-operative, intra-operative and post-operative determinants for the post- cholecystectomy syndrome.Methods: This is the prospective study, done in the Department of Surgery, Dr BSA Medical College and Hospital, New Delhi. Total 102 number of patients were included in this study, out of which 51 patients underwent open and another 51 patients underwent laparoscopic cholecystectomy.Results: The mean age of the patients was 40.29±10.69 years with an age range of 19 to 80 years. Incidence rate of post cholecystectomy symptoms were16.66% (n=17). Incidence of post-cholecystectomy syndrome in patients who underwent laparoscopic cholecystectomy were 15.69% (n=8) while in the open cholecystectomy group it was 17.64% (n=9). Out of seventeen symptomatic patients, eight (47.05%) were having the biliary disease while nine patients (52.95%) were having non-biliary cause.Conclusions: As authors studied present symptomatic group of patients thoroughly, it has become clear that the post-cholecystectomy symptoms are multiple and diverse arising from various causes; which in reality has no relation with the removal of gall bladder. Hence the appellation ‘post-cholecystectomy syndrome is inappropriate and instead we have used the term ‘Post-Cholecystectomy Symptoms’ for these patients.

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