Unusually large number of gall stones removed through laparoscopic cholecystectomy from a single patient- A case report

Gallstone disease is characterized by the formation of calculi in the gall bladder or the biliary tract. It may be asymptomatic or present as biliary colic or with complicated disease. Laparoscopic cholecystectomy is the mainstay of treatment for symptomatic gall stones. We describe a case of Gallstone disease in a 43-year-old female, where over seven thousand stones were removed through a Laparoscopic procedure. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

A Study of Chemical Composition of Gall Stones in a Tertiary Care Hospital.

Gallstones are a major health problem & have been recognized since antiquity. Gallstones are generally classified into pure cholesterol, pigment and mixed type. Knowing the chemical composition of gallstones is essential for determining etiopathogenesis of gallstone disease. Fourier Transform Infrared Spectroscopy (FTIR) method is the most widely used technique in chemical analysis of gall stones. Reports on chemical analysis of gallstones are available from different endemic regions of India. However, no reports are available about the composition and etiopathogenesis of gallstones in Himachal Pradesh. METHODSGallstones from 400 patients of cholelithiasis were collected after cholecystectomy at Indira Gandhi Medical College Hospital (I.G.M.C.), Shimla, between June 2016 to June 2018, and were subjected to chemical analysis by FTIR method. The data was further correlated with regard to age, gender, socio-economic status, various life style factors like diet, obesity, physical activity, with stone number and colour. RESULTSChemical analysis of gall stones revealed that pure cholesterol, mixed and pigment variety were 94 %, 2 % and 4 % respectively. Majority of the patients were below the age of 50 years (66 %). Male to female ratio was 2.7:1. Both sexes had predominantly pure cholesterol stones. Most of the patients belonged to the lower middle class (56.5 %) & all socio-economic classes showed predominantly pure cholesterol stones. Similarly, there was no predilection of any type of stone to a particular physical work category. 53.5 % patients were non-vegetarians and 46.5 % were vegetarians. There was no correlation between diet and BMI with type of stones. In our study, 66 % of patients had multiple stones. Multiple stones were seen in all varieties of stones. Pure cholesterol stones showed a variety of colours contrary to traditional classification. CONCLUSIONSIn Himalayan population, the predominant type of gall stones were pure cholesterol stones. Mixed stones and pigment containing stones were found in much smaller frequencies. This result is in contrast to that of rest of the Indian subcontinent from where larger percentage of pigment and mixed stones has been reported. And pure cholesterol stones showed maximum variation in colours contrary to our expectation.

Correlation between serum ferritin and gall stones

Background: The incidence of gall stones is in increasing trend. The old axiom that a typical gall stone sufferer is a fat, fertile, female of fifty, is only partially true, as the disease is found in women soon after their first delivery, in underweight and thin people. So, while searching for other parameters, iron deficiency was found to be a new parameter of interest in the aetiology of gall stones.7Methods: 50 cases of cholelithiasis and 40 cases of anaemia with low serum ferritin levels from September 2017 to August 2019 was studied. Serum iron was estimated by carbonyl metallo-immunoassay method. Serum cholesterol was estimated by the CHOD-POD Enzymatic method. Biliary cholesterol was estimated after extraction of biliary lipids from bile from the gallbladder specimen of the patients by the method of Folch et al which was followed by the procedure similar to the analysis of serum cholesterol by CHOD-POD enzymatic method. Fischer’s chi square exact test was used as statistical method.Results: It was observed that 70% of the group A study group with cholelithiasis had normal serum ferritin levels and 30% had low serum ferritin levels. It was observed that 95% had normal sonographic findings and 5% had cholelithiasis with normal ferritin levels in group B.Conclusions: In our study low serum ferritin levels with cholelithiasis was associated with raised bile cholesterol levels and so it can be concluded that low serum ferritin level is causing biliary stasis and hence leading to increase in the incidence of cholelithiasis.

Fundus first laparoscopic cholecystectomy in patients with gall stone disease and the Fitz-Hugh-Curtis syndrome

Background: To present this experience using the fundus-first technique during laparoscopic cholecystectomy for the management of symptomatic gall stone disease with an intra-operative finding of Fitz-Hugh-Curtis syndrome.Methods: This is a prospective review of patients who had the fundus-first dissection during laparoscopic cholecystectomy. The study was carried out at the Jos University Teaching Hospital (JUTH), and FOMAS hospital, both of which are tertiary hospitals located in Jos. Patients were recruited from January 2017 - January 2019. All patients undergoing laparoscopic cholecystectomy who had an intraoperative diagnosis of Fitz-Hugh-Curtis syndrome, and who had the fundus-first dissection, were included in the study. Patients who had fundus-first dissection for indications other than Fitz-Hugh-Curtis syndrome, were excluded from the study. Demographic and clinical information of patients included age, sex, duration of surgery, complications, and duration of hospital stay. Descriptive statistics were applied.Results: A total of 76 patients had elective laparoscopic cholecystectomies over the study period. Of that number, 17 (22.4%) patients had an intra- operative diagnosis of Fitz-Hugh-Curtis syndrome, and had the fundus-first dissection. The mean patient age was 46.3 years (SD = 11.7 years). All patients were female. The mean operating time was 70 minutes (SD = 23 minutes). The duration of hospital stay was 24 hours. There was one conversion due to uncontrollable intraoperative bleeding.Conclusions: This study revealed that the fundus-first dissection is suitable for removing the gall bladder during laparoscopic cholecystectomy in patients with gall stone disease, and an intraoperative finding of Fitz-Hugh-Curtis syndrome.

Histopathological spectrum of gall bladder lesions

Background: Gall bladder diseases are a very common health problem that affects millions of people throughout the world. Cholelithiasis is commonly associated with carcinoma gallbladder. Cholecystectomy is the most commonly performed surgical procedure done for gall bladder disease.Methods: A total of 161 cases of gall bladder lesions were evaluated from January 2017 to December 2018 which were sent to department of pathology. Specimens were fixed in 10% formalin. Appropriate areas were selected from the specimen and grossed, processed, sectioned, stained using haematoxylin and eosin and were observed under microscope.Results: Out of 161 cases, 105 were female (65.22%) and 56 cases were male (34.78%).Histopathologically, the most common diagnosis was Chronic calculus cholecystitis (57.76%) followed by chronic acalculus cholecystitis (22.36%). Remaining cases were of Acute on chronic cholecystitis (6.21%), Acute on chronic cholecystitis with cholelithiasis (4.96%), Acute on chronic cholecystitis with perforation peritonitis (1.24%), Acute suppurative cholecystitis with perforation peritonitis (0.62%), Biliary Atresia (1.24%), Chronic cholecystitis with choledochal cyst (1.24%), Follicular cholecystitis (1.24%), Adenocarcinoma (0.62%), Adenosquamous carcinoma (0.62%) and one case was inconclusive (0.62%).Conclusions: The incidence of chronic calculus cholecystitis was found to be 57.76% with female preponderance and mostly in third decade. Malignancy of gall bladder is a rare condition. Routine histopathological examination of all cholecystectomy specimens is strongly recommended for the detection of various variants of chronic cholecystitis and also of incidental carcinoma of gall bladder which helps in their treatment and prognosis.

An Observational Study on Association of Gall Stone Disease and Iron Deficiency in the Population of Kolhan Region of Jharkhand

Background: Gallstone disease is common gastrointestinalproblem encountered in day to day practice. Super saturationof bile in cholesterol, enhanced nucleation of cholesterol,impaired gallbladder emptying and intestinal hypo motilityfavors the formation of gallstones. Consumption of diet rich incarbohydrates but deficient in iron alters hepatic metabolism ofcholesterol and promotes cholesterol crystal formation.Objective: To correlate iron deficiency anemia with gallstonedisease in Kolhan region of Jharkhand.Materials & Methods: A prospective study was conductedduring period of one year in department of surgery MahatmaGandhi Memorial Medical College Hospital, Jamshedpur. 50patients with ultrasonographically proven gallstone diseaseadmitted in surgery department during this period wereincluded in the study. 50 individuals admitted in surgerydepartment, not suffering from gall stone diseases were takenas control group. Subjects were divided into two groups anemicand non-anemic based on Hemoglobin% and serum iron.Serum cholesterol of both the groups was estimated.Results: Female was affected more in case and control groupwith mean age 39.72±15.382.Conclusion: Iron deficiency anemia plays a significant role insuper saturation of bile with cholesterol leading to gallstoneformation.

Gall bladder stones: surgical treatment.

Background: There is higher incidence of gall stones in Karnataka and more commonly seen in women aged between 25 to 55 years. In this study men are also encountered with gall stone. As all the gall stones cannot be removed by laparoscopic procedure, the complicated and adherent gall bladder with stones and where laparoscopic procedure is not available are removed by conventional open method of cholecystectomy and in this study open cholecystectomy procedure is dealt in detail. Methods: Open cholecystectomy through Right Kocher’s incision. Results: In this study of 10 cases with complications of gall stones dealt surgically by doing open cholecystectomy gave satisfactory postoperative results without much postoperative complications. Conclusions: Among 10 cases of open cholecystectomy 6 cases were done through duct first method and 4 cases were done through fundus 1st method, which gave good results and less postoperative complications.

Early intervention of acute pancreatitis accompanying choledocholithiasis by laparoscopic choledochotomy and choledochoscopy / 中华内分泌外科杂志

Objective To explore the feasibility and validity of laparoscopic choledochotomy and choledochoscopy for treament of patients with acute pancreatitis accompanying commom bile duct stones. Methods A total of 102 patients acute pancreatitis accompanying common bile duct gall stones were treated in our institution between January 2007 and November 2009. Among them, 43 patients underwent laparoscopic choledochotomy and choledochoscopy within 72h after admission entered our study group. They all had a laparscopic cholecystectomy and choleldochotomy and choledochoscopy to retrieve common bile duct stones. Of these, 13 patients undergoing pancreatic capsule incision and peritoneal lavage. Fifty-nine patients undergoing traditional conservative treatment firstly were used as a control group. Of these, 46 were performed laparscopic surgery and choledochotomy after smoothly recovery from pancreatitis. 13 underwent emergency open operation due to complications of pancreatitis. Results In the gastrointestinal function recovery time, amylase recovery time, length of stay and hospitalization cost, there was a significant difference between study group and the control group (P<0.05). Conclusions Our study provides evidence for the good clinical efficacy of early implementation of laparoscopic choledochotomy and choledochoscope for treatment of choledocholithiasis and acute pancreatitis.