Preoperative factors that determine technical difficulty during laparoscopic cholecystectomy for symptomatic calcular cholecystitis

The increasing experience in laparoscopic cholecystectomy has led to more difficult cases being performed The methods to identify a potentially difficult laparoscopic cholecystectomy would be a valuable indicator for good management policies with improvement of the outcome. The aim of this study was to determine the correlation between preoperative clinical and abdominal sonographic findings in patients undergoing laparoscopic cholecystectomy for symptomatic calcular cholecystitis and the technical difficulty at operation. All consecutive patients with calcular cholecystitis undergoing laparoscopic cholecystectomy for the last 8 years [531 patients] were reviewed. The clinical preoperative factors assessed involved patient's age, sex, body weight and body mass index, of the disease, associated diabetes mellitus, the occurrence of biliary colic within the last 3 weeks, the presence of symptoms and signs of acute cholecystitis at presentation and history of acute cholecystitis. The laboratory preoperative factors assessed involved, full blood picture including total leucocytic count, liver functions including serum transaminases, serum bilirubin and prothrombin time. The preoperative abdominal sonographic findings assessed involved gallbladder size, gallbladder wall thickness, peri-cholecystic fluid, gallstones number and size and the liver condition. Laparoscopic cholecystectomy was attempted in all patients. Operative data were compared to preoperative data of all patients and statistically analyzed. It was found that the following 7 parameters are independently predictive of a difficult operation: male sex [p<0.01], the presence acute cholecystitis [p<0.01], thickening of the gallbladder wall [p<0.01], shrunken gallbladder [p<0.01], mucocele of the gallbladder [p<0.05] and enlarged liver [p<0.05] or liver cirrhosis [p<0.05]. The above-mentioned factors are important and should help to select patients for either laparoscopic or open cholecystectomy based on the expected difficulties

cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done [HBsAg and anti-HCV antibodies]. The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg sero positive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin Bi and chromium had the highest odds ratios among the studied variables, [odds ratios were 2.5 and 2.4, respectively]. Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones [odds ratios were 7.2 and 4.5, respectively]. Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future