Gall Bladder Polyps : A Paradigm Shift – Need for Reappraisal of Guidelines

Background : Gall Bladder Polyps are mucosal lesions that project from the Gall Bladder wall into the Gallbladder lumen. They form morphologically distinct lesion/s with internal characteristics different than that of neighboring structures as verified by microscopic examination. About 4-6% are picked up clinically, 2-12% in Cholecystectomy specimens and 4% on Ultrasound. Materias and Methods : A three calendar year retrospective single surgical unit study compromised of 1442 cholecystectomies performed for benign Gall Bladder Disease. The patient were subjected to Ultrasound of abdomen for diagnosis and routine clinic work up. The Gall Bladders Harboring Polyps were examined grossly for site ,number, and microscopy for histological details. Results : In a total number of 40 cases of Gall Bladder Polyp, females outnumbered males. This series spreads over age groups of 3rd decade - 9th decade, most of the patients were seen in 6th decade of life. Youngest patients were 27 years old and oldest one was 85 years old. Incidentally, none of the old patients had evidence of malignancy on histopathology in their Gall Badder Polyp, only 2% were necessitated for a pre-operative diagnosis of Gall Bladder Polyps alone. Rest required it for presence of Gallstones with or without Polyp. None of >10mm size showed any malignant change on histopathological examination. On the Contrary, among the polypoid lesions <10mm size, one polypid lesion (7mm) showed a malignant change (Carcinoma in situ) Conclusion : A predictive model for neoplastic potential of Gall Bladder Polyp may support clinical decision to achieve an ideal therapeutic outcome. Hence a need for reappraisal of management guidelines.

Laparoscopic Spleenectomy.

Spleen is the largest reticuloendothelial organ in the body consisting of an encapsulated mass of vascular and lymphoid tissue and responsible for defensive actions and hence the name defense organ for it. Like any other organ in the body it is also afflicted by a number of disorders among which are splenic cysts. Herein we report a case of large primary splenic cyst that was treated successfully by laparoscopic Spleenectomy.

Laparoscopic Adrenalectomy-Our Experience.

Adrenal glands are known to be central to homeostasis and consequently their afflictions are responsible for majorhuman ailments. Laparoscopic adrenalectomy has become the procedure of choice for handling these benign functioning and non-functional afflictions. Recently, literature has documented the feasibility of laparoscopic procedure for even the larger (>5cm) tumors. We present our first-hand experience with ten laparoscopic adrenalectomies done at our center for adrenal masses upto 6cm in diameter.Ten patients with adrenal masses upto 6cm in diameter underwent laparoscopic adrenalectomy at our department between Jan 2010 and Jan 2013. There were 7 males and 3female patients. There were six left sided tumors and four right side tumors with an average tumor size of 4.5cm. Seven out of ten cases had functional tumors. All of the procedures were completed successfully without any major intraoperative complication. The mean (range) operating time was 130 (100-210) min. There was an average (range) blood loss of 200 (150-400) ml. A drain was kept in all the patients and removed mostly on 1st postoperative day. The patients were strictly followed up after the surgery and none of them developed any complication. From our favorable results, we can safely conclude that laparoscopic adrenalectomy is safe and feasible procedure especially for smaller tumors. More experience is needed to tackle the larger size tumors.

Cholecystoduodenal Fistula: An Intraoperative Diagnosis.

We report a case of chronic cholecystitis that had no preoperative diagnosis of cholecystoduodenal fistula but was found during laparoscopic cholecystectomy and was managed successfully. I