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PubMed2000

[Evolution of the technique and indications of mini-invasive surgery of cholelithiasis].

BACKGROUND: A review of the experience with laparoscopic cholecystectomy to evaluate the impact of the efficacy, safety, and complications on the learning curve. STUDY DESIGN: Retrospective study. METHODS: Between 1993 and 1998, 415 patients, 123 males and 292 females, median age 52.1 years (range 23-96 years), with symptomatic cholelithiasis, underwent laparoscopic cholecystectomy. On the basis of different selection criteria and surgical techniques adopted, our experience was divided into two periods (93-95 and 96-98). RESULTS: The success rate was 89.4% (371 patients) with a conversion rate of 10.6% (44 patients). Overall complications rate was 2.9% (12 patients): 7 major complications (2 biliary tract injuries, 2 hemorrhages, 1 sub-phrenic abscess, 1 gastric perforation and 1 choleperitoneum) and 3 minor complications (1 biliary leakage and 2 wound infections) with 2 long-term sequela (umbilical site eventration). Median hospital stay was 3.3 days, 2.2 days for uncomplicated cases and 5.6 in those converted or complicated. Comparison between the two groups showed a conversion rate of 10.6 vs 10.4% (23 vs 21 patients), with a complication rate of 4.2% vs 2.2%. CONCLUSIONS: Laparoscopic cholecystectomy can be considered a safe and effective procedure for the treatment of simple or complicated cholelithiasis. French surgical technique seems to be easier in the management of acute cholecystitis or lithiasis occurring after acute pancreatitis. Specific training in laparoscopy surgery is mandatory to avoid major complications.

Adult↗
PubMed2001

Gallbladder pathologies and cholelithiasis.

OBJECTIVE: Cholecystectomy, mostly due to cholelithiasis is one of the most common surgical procedures utilizing a significant amount of healthcare resources. As there are a huge number of cases, for example approximately 300 cases per year in our region, outlines this commonly encountered lesion should be recorded. Also, in an attempt to delineate the outline of the pattern, age and sex distribution of gallbladder diseases in the whole Kingdom, a comparative analysis is also included in this study with 7 other studies published from different parts of the Kingdom. METHODS: Our study consisted of 740 consecutive gallbladder cholecyctectomies mostly for cholelithiasis received in a time frame of 3.5 years (for example between January 1997 through to May 2000) by the Department of Histopathology retrieved from the records of the laboratory. The outline of main gallbladder pathologies was tabulated. The number of gallbladders received with stones was also calculated. Age and sex distribution for gallbladder pathology and gallstones was also tabulated. RESULTS: There were 131 males (18%) and 609 (82%) females, with a female ratio male 4.6:1. Benign lesions comprised 99% (mean age 36), mostly chronic cholecyctitis (97%) and acute cholecystitis which constituted 15 cases only (2%), malignant lesions comprised only 7 cases for example 1% of all lesions (mean age 65). CONCLUSION: Gallbladder pathologies are very common and similar results have been obtained from other studies by comparative analysis. The mean cholecystectomy rates in the Kingdom totalled approximately 10%, mean age for all cholecystectomy diseases in both sexes equalled 37.05. The mean age for males was 42.26, females 37.25 and their ratio was 44.5:1.

Adult↗
PubMed2001

[Immunomorphologic detection of apoprotein B antigenic determinants in the gallbladder wall in cholesterosis and cholelithiasis].

The presence and location of apoprotein B (Apo B) antigenic determinants in cholesterosis and cholelithiasis in gall bladder wall were detected for elaboration of modified Apo B role in pathogenesis of these diseases. Macroscopically changed parts of gall bladder (GB) wall of patients with gall bladder cholesterosis (GBC), and also macroscopically unchanged parts of GB wall of patients with cholelithiasis (CL) after cholecystectomy were studied. Macroscopically unchanged parts of GB wall obtained during autopsy of persons without symptoms of GB pathology were used as a control. Apo B location was studied with monoclonal (MAB 5F8 to Apo B) and polyclonal (PAB) antibodies; Apo B modified by malonic dialdehyde and oxidized by Cu2+ (4C11), Apo A with MAB1C5. Antibodies to CD 68 (specific marker of macrophages) was positive control, antibodies to trichinella--negative control. The most intensive accumulation of modified Apo B was revealed in foam cells region with accumulate lipids and form polyps that testifies to connection of apoproteins with lipids and foam cells and suggests their role in pathogenesis of GBC. More intensive staining of GB epithelial cells, particularly on GB peripheral parts by antibodies to apoproteins compared with surrounding tissues shows that bile is the source of detected modified apoproteins. Increase of absorption and accumulation of apoproteins in GB wall were also revealed in CL but these processes are less intensive than in GBS.

Adult↗
PubMed2001

[Galstena efficacy in patients with biliary dyskinesia, chronic cholecystitis and cholelithiasis].

The response of inflammation, bile secretion, lipid metabolism, LDL sensitivity to oxidation was studied in patients with bile duct dyskinesia (BDD), chronic cholecystitis (CC) and cholelithiasis (CL) before and after a course of therapy with galstena. The treatment improved general condition in 90% of the patients, dyspeptic symptoms relieved or stopped. Galstena relieved general or local inflammation, reduced mean levels of total cholesterol and LDL cholesterol, raised HDL cholesterol. In patients with BDD and cholelithiasis galstena did not change normal sensitivity of LDL to oxidation. A galstena course in BDD and CC patients significantly diminished bile lithogenicity and improved gall bladder contractility.

Adolescent↗
PubMed2001

Cholelithiasis in a child--an unusual presentation of Wilson's disease.

A nine year old mentally retarded girl with moderate splenomegaly and ascites presented with chronic cholelithiasis. The presence of Kayser-Fleischer rings and low serum ceruloplasmin level confirmed the diagnosis of Wilson's disease. Cirrhosis of liver and recurrent episodes of hemolysis--these two common complications of Wilson's disease make an ideal setting for gall stone formation. Only three such cases have been reported worldwide and ours is the first case report from India. We suggest that cholelithiasis and splenomegaly in a child without evidence of congenital hemolytic disease should be taken as a suspect of Wilson's disease.

Child↗
PubMed2001

[Bile crystallography and viscosimetry in cholelithiasis].

High prevalence of cholelithiasis necessitates development of an easy screening diagnostic method, and therefore structural analysis of a dried drop of biological fluid attracts special attention. A new method, clinical crystallography, has been used for analysis of bile from patients with cholelithiasis. A relationship between the crystal morphology and biological fluid viscosity has been revealed.

Adult↗
PubMed1975

Cholelithiasis and cholecystitis in children.

Case reports of four children with cholelithiasis and cholecystitis without clear-cut etiology are discussed. Symptoms in children are frequently not specific and do not readily suggest cholecystopathy. The diagnosis of cholecystitis and/or cholelithiasis should be considered in cases of children with vague, recurrent abdominal complaints, pyrexia, nausea and vomiting. In children presenting these symptoms, an X-ray survey of the abdomen is indicated in view of the increased possibility of demonstrating gall stones. No cause of this phenomenon could be demonstrated in our material, since routine analysis of calculi was not performed.

Adolescent↗
PubMedDate not supplied

Histopathological changes in gallbladder mucosa in cholelithiasis: correlation with chemical composition of gallstones.

BACKGROUND: Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely acute inflammation, chronic inflammation, glandular hyperplasia, granulomatous inflammation, cholesterosis, dysplasia, and carcinoma. Gallstones have different chemical composition. They may be cholesterol, pigment or mixed stones. The aim of this prospective study was to see if any correlation existed between the chemistry of gallstones and any particular histopathologic picture. METHODS: Between May 1997 and December 1997 we diagnosed and operated on 40 patients with cholelithiasis. Diagnosis was established by ultrasound. After operation gallstones were sent for chemical analysis to detect presence of calcium bilirubinate and cholesterol. Serial sections of gallbladder from fundus to neck were stained by haematoxylin and eosin, and studied. RESULTS: Out of 40 patients (n = 40) 29 were females and 11 were males. The mean age of our patients was 38 +/- 21 years with a median of 40 years. Median age of males was 48 years compared to 38 years for females. Twenty-eight patients had mixed stones, 8 had pigment stones and 4 had cholesterol stones. Out of 28 patients with mixed stones 14 had histological picture of chronic cholecystitis, 8 had granulomatous cholecystitis, 4 had adenomatous hyperplasia, 1 had dysplasia and 1 had carcinoma. All 8 patients having pigment gallstones had chronic cholecystitis. Out of 4 patients with cholesterol gallstones, 2 had chronic cholecystitis, 1 had adenomatous hyperplasia and 1 had cholesterosis. Gallbladder having pigment stones were devoid of Rokitansky-Aschoff sinuses. CONCLUSION: Adenomatous hyperplasia and Rokitansky-Aschoff sinuses were not seen in gallbladder containing pigment stones but seen in gallbladders containing mixed and cholesterol stones in our study. Cholesterol may be a more potent stimulus for glandular hyperplasia or glandular hyperplasia may responsible for formation of cholesterol rich stones.

Adult↗
PubMed2002

[Natural history of cholelithiasis and incidence of cholecystectomy in an urban and a Mapuche rural area].

BACKGROUND: Cholelithiasis is the second cause of hospital admissions in Chile. AIM: To study the prevalence of symptomatic gallstone disease and opportunity of cholecystectomy in La Florida, Santiago and among Mapuche Indians in Huapi Island. PATIENTS AND METHODS: In the period 2000-2001, we contacted to 71% (1127 subjects) and to 61% (145 subjects) patients of La Florida and Huapi Island, respectively, that had previously participated in an epidemiological study on cholelithiasis in 1993. We defined symptomatic gallstone patients as those with a history of biliary colic. Each patient was subjected to gallbladder ultrasound. RESULTS: In 1993, 30-35% of gallstone patients were symptomatic (approximately 70% women). During the lapse 1993-2001, only 50% of subjects from La Florida and 25% of patients from Huapi Island were cholecystectomized (p < 0.05). Fifty percent of cholecystectomies were emergency operations. In 38 symptomatic Mapuche Indians from Huapi, cholecystectomy was indicated in 2001. After five months of the indication, only one of these subjects had been operated. Laparoscopic cholecystectomy represented 40% of all cholecystectomies performed in the National Health Service Hospitals. CONCLUSIONS: This study demonstrates an unacceptable high prevalence of symptomatic gallstone patients remaining non-operated in both the urban and rural communities. This reciprocally correlates with the high frequency of emergency cholecystectomies and the high incidence of gallbladder cancer among Chileans. This study contrasts negatively with the situation of Scotland, where 73.5% of cholecystectomies were laparoscopic in 1998-1999. To reach Scotland standards, the Chilean Public Health System should increase the number of cholecystectomies from 27,000 in 2001 to 57,510

Adult↗
PubMed2002

Does gallbladder ejection fraction predict pathology after elective cholecystectomy for symptomatic cholelithiasis?

Patients with symptomatic cholelithiasis are selected for elective cholecystectomy with the expectation that their symptoms will improve after operation. However, some patients fail to improve because their preoperative symptoms were not related to gallbladder disease. A test that would indicate the severity of gallbladder disease in patients with gallstones would therefore have great potential benefit. Twenty-five patients who presented as outpatients with episodic abdominal pain and gallstones were scheduled for elective cholecystectomy. On the day before operation patients underwent nuclear medicine cholescintigraphy with measurement of ejection fraction. All patients then underwent laparoscopic cholecystectomy. Pathologic specimens were reviewed by a pathologist who was blinded to the ejection fraction results and scored for degree of inflammation on a scale of zero to three. There was a wide range of ejection fractions measured (0-84%). There was, however, no correlation between ejection fractions and degree of gallbladder inflammation. We conclude that gallbladder ejection fraction does not predict the degree of gallbladder inflammation at the time of elective cholecystectomy. This test is therefore unlikely to predict which patients with cholelithiasis will have symptomatic relief after cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed2002

[Use of drainage in endoscopic video-assisted surgical treatment of cholelithiasis].

Under investigation were the nearest results of using a modified fashine drain in treatment of 57 patients operated laparoscopically for a complicated cholelithiasis. The method was shown to have both advantages and adverse effects as compared with the traditional kinds of drainage. The indications to drainage with a fashine drain after a laparoscopic procedure for complicated cholelithiasis were established and investigated.

Adult↗
PubMed2003

Treatment of cholelithiasis in children with sickle cell disease.

Medical and surgical advances have improved the treatment of cholelithiasis (ie, gallstones) in children with sickle cell disease (SCD). Children with SCD have an increased risk of developing pigment gallstones that initially may be asymptomatic but that can lead to acute symptoms of cholelithiasis. An elective laparoscopic cholecystectomy procedure is recommended for pediatric patients with SCD to prevent the risk of requiring an emergency cholecystectomy procedure. The primary benefits of this approach include a shorter hospital stay after surgery, decreased postoperative discomfort, decreased risk of complications, and a quicker return to normal activities.

Anemia, Sickle Cell↗
PubMedDate not supplied

[Diagnostic capabilities of the x-ray endoscopic method of study in cholelithiasis].

The developed variants of the roentgenoendoscopic method for the examination of the pancreatobiliary system were employed in 256 patients with various diseases of the gallbladder and biliary duct. The results of application of these methods in 85 patients with cholelithiasis are presented. Different potentialities of the roentgenoendoscopic method and ultrasonic scanning for the assessment of the biliary system status in cholelithiasis were revealed. The findings recommend supplementing ultrasonic examinations with an optimal variant of the roentgenoendoscopic examination.

Adult↗
PubMed1992

[Immune complex in the wall of the gallbladder in patients with cholelithiasis: deposition and its pathological significance].

The gallbladder specimens from 53 patients with cholelithiasis were studied by immunohistochemical method. Deposition of immune complex (IC) was observed on the mucosal and glandular epithelium in 84% of patients with gallstones and 47% of patients with choledocholithiasis. IgG and C3 were the most frequent complement component demonstrated at the site of IC deposition, but Clq, factor B and C4 were also present in many cases, suggesting the local complement activation. We conclude that IC may play a pathogenetic role in the injury of the mucosa and tissue of gallbladder in patients with cholelithiasis.

Antigen-Antibody Complex↗
PubMed1992

Cholelithiasis associated with medroxyprogesterone acetate therapy in men.

Five out of forty-five adult men, 50 years of age or less, who had received, for at least six months, medroxyprogesterone acetate (MPA, Depo Provera) IM, 200-400 mg/week, for prevention of sex-offending or genital-mutilating behavior developed symptomatic cholelithiasis. Thirty of these men were studied with gallbladder ultrasound prospectively off MPA and at six-month intervals while taking the medication and then six months off MPA. Gallstones recovered from two patients were found to have very high cholesterol content, suggesting they were formed in cholesterol supersaturated bile. These findings are consistent with the increased incidence of gallbladder disease related to high-progesterone states and suggest that MPA may be a causative agent in cholelithiasis. The physiologic studies on gallbladder contraction and cholecystokinin release in a subset of the patients failed to provide information on a mechanism for the possible increased incidence of gallbladder disease.

Adult↗
PubMed1992

[The effect of chenotherapy on the reservoir function of the gallbladder in cholelithiasis patients].

The effect of chenodeoxycholic acid (CDCA) on the reservoir function of the gallbladder was studied in 46 patients with cholesterol cholelithiasis. There was a dependence between a clear increase of filling of the gallbladder in patients treated by this method with subsequent sharp reduction of its size and development of dyspepsia and diarrhea. In 14 patients increase of the gallbladder against the background of chemotherapy was not authentic but no dyspeptic phenomena occurred. Thus, decompensation of the reservoir function of the gallbladder in patients with cholelithiasis against the background of chemotherapy are manifested by a significant increase of the gallbladder size with subsequent emptying of bile into the duodenum and development of collagenous diarrhea.

Adolescent↗