A clinical study: prevalence and management of cholelithiasis
Keywords:Cholelithiasis, Gallstones, Cholecystectomy, Laparoscopy
Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system. The impaired metabolism of cholesterol, bile acids and bilirubin are characterized by gallstone formation. The prevalence of cholelithasis varies and has been reported as 2-29% in India, and increased in the recent years. In the present study, apart from studying the epidemiology i.e., demographic factors, dietary habits, clinical presentation, diagnostic tools and management, it also looks at the stone analysis, bile culture and complications after surgery in rural population in central India. To study the modes of presentation of gallstones, various treatment modalities, their outcome and complications and chemical analysis of gallstones in relation to the type of diet.
Methods: Department of Surgery at NPK Salve Institute of Medical Sciences, Nagpur, from September 2010 to October 2012 on 104 patients fulfilling the inclusion criteria selected for the study. Clinical symptoms were noted according to clinical history of the patients. The ultrasonography scanning of the abdomen performed, open/laparoscopic cholecystectomy was done.
Results: The mean age of the patients was 43.56 years with a male-female ratio of 0.52:1. Mixed type of diet, and multiple gallbladder calculi of mixed type was observed. Wound infection was the commonest complication in open cholecystectomy group, and the mean hospital stay was significantly more in this group.
Johnston DE, Kaplan MM. Pathogenesis and treatment of gallstones. N Engl J Med. 1993;328:412-21.
Shaffer EA. Epidemiology and risk factors for gallstone disease: Has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7(2):132-40.
Belousov Yu V. Pediatric Gastroenterology. Up-to-date Guide. Moscow: Exma; 2006: 112.
Méndez-Sánchez N, Zamora-Valdés D, Flores-Rangel JA, Pérez-Sosa JA, Vásquez-Fernández F, Lezama-Mora JI, et al. Gallstones are associated with carotid atherosclerosis. Liver Int. 2008;28:402-6.
Temel RE, Brown JM. A new framework for reverse cholesterol transport: Non-biliary contributions to reverse cholesterol transport. World J Gastroenterol 2010;16(47):5946-52.
National Institute of Diabetes and Digestive and Kidney Diseases. Digestive Diseases Statistics. Bethesda: U.S. Dept of Health and Human Services, NIH Publication; 1995: 95-3873.
Lopis S. The incidence cholelithiasis in the Bantu. Clin Proc 1947;6(8):338-47.
Biss K, Ho KJ, Mikkelson B, Lewis L, Taylor CB. Some unique biologic characteristics of the Masai of East Africa. N Engl J Med 1971;284:694-9.
Mhamunkar SR, Bapat RD, Mahadik SP, Abhyankar BA. Epidemiological study of cholelithiasis: Indian context: BY. Available at http://www.indian-doctor.com/papers/nutri/gallston.htm. Accessed 09 Jun 2014.
Battacharya R. Cholecystectomy in west port, New Zealand. Indian J Surg. 1983:450-5.
Tamhankar AP, Nigam K, Houghton PW. The fate of gallstones: Traditional practice questioned. Ann R Coll Surg Engl. 2003;85(2):102-4.
Ganey JB, Johnson PA Jr, Prillaman PE, McSwain GR. Cholecystectomy: Clinical experience with a large series. Am J Surg. 1986;151(3):352-7.
Sharma MA. Towards a safer cholecystectomy - The fundus to porta approach. Indian J Surg. 1997;59(4):141-5.
Thamil Selvi R, Sinha P, Subramaniam PM, Konapur PG, Prabha CV. A clinicopathological study of cholecystitis with special reference to analysis of cholelithiasis. Int J Basic Med Sci. 2011;2(2):68-72.
Chandran P, Kuchhal NK, Garg P, Pundir CS. An extended chemical analysis of gallstone. Indian J Clin Biochem. 2007;22(2):145-50.
Pundir CS, Rani K, Garg P, Chaudhary R, Chandran P, Kumari M. Chemical analysis of biliary calculi in Haryana. Indian J Surg. 2001;63:370-3.
Mohan H, Punia RPS, Dhawan SB, Ahal S, Sekhon MS. Morphological spectrum of gallstone disease in 1100 cholecystectomies in North India. Indian J Surg. 2005;67:140-2.
Vitetta L, Sali A, Little P, Mrazek L. Gallstones and gallbladder carcinoma. Aust N Z J Surg. 2000;70:667-73.
Hsing AW, Gao YT, Han TQ, Rashid A, Sakoda LC, Wang BS, et al. Gallstones and the risk of biliary tract cancer: A population based study in China. Br J Cancer. 2007;97:1577-82.
Domeyer PJ, Sergentanis TN, Zagouri F, Tzilalis B, Mouzakioti E, Parasi A, et al. Chronic cholecystitis in elderly patients. Correlation of the severity of inflammation with the number and size of the stones. In Vivo. 2008;22(2):269-72.
Khanna R, Chansuria R, Kumar M, Shukla HS. Histological changes in gall bladder due to stone disease. Indian J Surg. 2006;68:201-4.
Maskey CP, Shrestha ML, Sato Y. Gallstone in TUTH. JIOM. 1990;12:45-54.
Cuevas A, Miquel JF, Reyes MS, Zanlungo S, Nervi F. Diet as a risk factor for cholesterol gallstone disease. J Am Coll Nutr. 2004;23(3):187-96.
Taylor EW, Guirguis LM, Johna SD. Laparoscopic cholecystectomy in histologically confirmed acute cholecystitis. J Laparoendosc Surg. 1996;6(4):227-32.
Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227(4):461-7.
Schwesinger WH, Sirinek KR, Strodel WE 3rd. Laparoscopic cholecystectomy for biliary tract emergencies: State of the art. World J Surg. 1999;23(4):334-42.
Schlumpf EA. Epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20:981-96.
Fajardo R, Valenzuela JI, Olaya SC, Quintero G, Carrasquilla G, Pinzón CE, et al. Cost-effectiveness of laparoscopic versus open cholecystectomy. Biomedica. 2011;31(4):514-24.