Cholelithiasis and cholecystitis: a personal experience with 150 cases

ABSTRACT

A retrospective study was performed on one hundred and fifty cholecystectomies performed over the last few years in Public and private Hospitals by one Consultant Surgeoh. All data were analysed; and those showed a female male ratio of 41, and a peak age of 41-50 years. 13.7% of Cholecystectomies had exploration of the common bile duct; 72.7% of them were jaundiced, and 27.3% of those who had common bile duct exploration were not jaundiced choledocho-duodenostomy or a sphincteroplasty was performed when exploration of the common bile duct was negative showed sludge only, or there was a very large number of very small stones. 90.7% of Cholecystectomies were for calculous cholecystitis, and 9.3% were for acalculous cholecystitis. Diagnosis of acaluculous cholecystitis was made by ultra sonography and oral cholecystography. with 21.4% of them having a Hida-hepatobiliary scintiscan as well. All 9.3%. of cases of acalculous cholecystitis had a histopathological confirmation of chronic acalculous cholecystitis. 18.7% of patients had acute cholecystitis at operations with 39.3% of these patients with acute cholecystitis having empyema of the gall bladder; all of these patients were treated by cholecystectomy, and none of them had a cholecystostomy. of the 136 patients with calculous cholecystitis, 19.9% had a solitary stone and 32.4% had 2-10 stones; the highest number of stones was 250. 49.2% of stones were less than one centimeter in size; with the biggest stone being 4.5 cms in size. In 14% of cases, two different sizes of stones were encountered in the gall bladder and in 5.2% of cases, three different stone sizes were encountered. Unlike what is expected of "mixed stones" they were not the commonest gall stones in this study constituting only 30.9% of cases with " cholesterol stones" constituting 40.4% of cases. "Pigment stone" constituted only 8.8% of stones; with " combined stones" constituting 17.6% of cases. 2.7% of patients had carcinoma of the gall bladder all occuring in patients with calculous cholecystitis, with a female male ratio of 11., motality was 1.3%, and 1.3% had liver cirrhosis with secondary gall stones. The literature have also been reviewed