European Journal of Molecular & Clinical Medicine

To examine whether or not preoperative ultrasonography results were related to surgical outcome in laparoscopic cholecystectomy.
Methods: After clearance from institutional ethical committee, 50 patients with diagnosed Cholelithiasis, who underwent laparoscopic cholecystectomy in department of General surgery HIMS, Sitapur from Janurary2021 to October 2022, were selected after meeting inclusion and exclusion criteria. Patients with Acute Cholecystitis, presenting within 72 hours of onset of pain and all patients, of any age group & sex after six week of acute phase of Cholecystitis with Cholelithiasis on USG were included in the study. A total of 50 patients were included in the study.
Results: More than one third of patients were 30-40 &>40 years of age (40%) followed by <30 (20%) years. Distended GB was the most common on pre-operative USG abdomen-Gall bladder(92%) and Multiple stone was the second most common on pre-operative USG abdomen-Gall bladder (72%). Easy operative status was among majority of patients (84%) and difficult was in 16% patients. Gall bladder with Operative status. Wall thickness>3 mm (p=0.009), Mucocele (p=0.02) and Chronic cholecystitis (p=0.001) were significantly associated Pre-operative USG abdomen: Gall bladder with Operative status. The mean hospital stay was 12.82±7.14 days.
Conclusion: GB Wall thickness>3 mm, Mucocele and Chronic cholecystitis  were significantly associated Pre-operative USG abdomen: Gall bladder with Operative status. Pre-operative USG abdomen: Calot’s with Operative status was significantly associated Pre-operative USG abdomen: Calot’s with Operative status. Intra-operative score was significantly higher among patients of Difficult than easy.

Background: Cholelithiasis is a chronic recurrent disease of the hepatobiliary system.
Gallstones are the major cause of morbidity and mortality throughout the world. With
atleast 10% of the adults have gallstones with a recent rise in the incidence due to
change in the dietary factors. This study aims to evaluate the demographic factors, its
various modes of presentation, treatment, outcome
Method: This prospective study was conducted on 100 patients in General
Surgery Ward, at Dr. D.Y. Patil Hospital and Research Centre, Pune for a period of
1 year who were diagnosed with cholelithiasis. Epidemiological aspects, Clinical
profile, investigation, treatment and outcomes were analyzed.
Result: The mean age of the patients was 36.82 years with male to female ratio
1:0.69. Pain abdomen was the most common symptom. Ultrasonography showed
gallbladder stones in all patients and 31% of patients undergone open
cholecystectomy and 65% underwent laparoscopic cholecystectomy. The
conversion rate of lap to open cholecystectomy was 4%. The average length of
post operative stay in Laparoscopic Cholecystectomy was 3 days and 7 days in
open cholecystectomy.
Conclusion: Laparoscopic cholecystectomy offers better surgical management with
reference to post operative pain, lesser number of hospital days and cosmetically
better

Background: The broad spectrum of biliary tract disease includes the most often diagnosed gallstone disease (cholelithiasis), cholecystitis, or biliary dyskinesia. The present study was conducted to assess etiology and outcome of cholelithiasis.
Materials & Methods: This was a hospital based, “cohort” study to assess etiology and outcome of cholelithiasis. Data was collected. All the patients received UDCA treatment. A treatment response was considered complete dissolution of gallstones, as determined by USG. Chi square test, Student’s t test and Mann–Whitney U tests were conducted for comparisons of variables using SPSS 19.0. Statistical significance was set at 0.05 in all tests.
Results: A total of 100 patients were enrolled in the study in which 40% were males and 60% were females. Maximum participants were of age group 31-40 years (32%). Most common etiology was advanced age (72%). Gallstones disappeared within six months after treatment 22 32% cases, and in 10% more by the end of 1.5 years. No change was observed in 58% cases.
Conclusion: The present study concluded that advanced age was the most common etiological factor. Only 32% Gallstones disappeared within six months after treatment

Cholelithiasis remains one of the most common problems leading to surgical intervention. Over the past few decades several studies to determine the causes and risk factors of gall stone formation have been done. But some factors like Socioeconomic status, Alcohol intake, Smoking, Serum Cholesterol level, Family history, Total parenteral nutrition (TPN), Crohn’s disease are still considered controversial regarding the formation of gall stone. Therefore, this work has been done with a view to study its relation to the mentioned predisposing risk factors, So prophylactic plan like dietary improvement, change in life style (e.g. cessation of smoking & alcoholism) & others measures should be taken to avoid gallstone formation.

Situs inversus totalis is rare condition with which one can live their life without any complications. Hence the diagnosis of the condition is usually incidental. The diagnosis of cholelithiasis in such patients in whom the underlying situs inversus has not been brought to light is not straight forward as the presenting complaint is usually on the opposite side. The management principles of cholelithiasis are the same as for a normal individual. The critical part of the management lies in the fact that conventional laparoscopic cholecystectomy, which is the definitive treatment of cholelithiasis, is suited for right handed surgeons for a gall bladder which is located in the right hypochondriac region. Since the gall bladder is located in the opposite side in above condition, safely carrying out the procedure has several challenges. This case report details the challenges faced in one such case of laparoscopic cholecystectomy in a case of situs inversus totalis.

Background: Gallbladder disease is known to affect a substantial number of people throughout the world. In India, the disease prevalence is on the rise, largely attributable to dietary & lifestyle changes, thus causing a significant disease burden. The purpose of this study is to evaluate the varied histological manifestations of gallbladder pathology and their association with cholelithiasis.
Materials & methods: This retrospective study was conducted in a tertiary medical centre in Patna from January 2020 to December 2020. The clinical data and the histopathological changes were evaluated.
Results: Of the 156 cases which were studied, 120 cases (77%) had gallstones. The mean age was 47 years. Females had a slight preponderance for gallbladder diseases with the Male: Female ratio being 1:2. 138 cases (88.5%) were diagnosed as chronic cholecystitis. 1.92% cases were diagnosed to have invasive malignancies.
Conclusion: A diverse spectrum of diseases affect the gallbladder encompassing inflammatory conditions, parasitic infections, pseudoneoplastic lesions and neoplasms. Routine cholecystectomy specimens should be evaluated meticulously as incidental findingss and diagnosis can be transformative.

Background: This research aimed to determine, prior to surgery, what factors, if any, could help a surgeon anticipate a "difficult cholecystectomy" using either laparoscopic or open surgery. Consecutive patients undergoing cholecystectomies (both open and laparoscopic) for gallstone-related disorders are analysed to see which factors best predict the presence or absence of surgical complications. The goal of this study is to determine which clinical, laboratory, and radiographic criteria are most indicative of difficult dissection during cholecystectomy. To develop a scoring system prior to surgery that can accurately predict the result during the procedure.
Results: A cholecystectomy is a common surgical procedure. Those who experience symptoms from gallstone disease are increasingly likely to opt for laparoscopic cholecystectomy. The incidence of both complications and conversions are higher in patients who are already at high risk, as well as in complex cases that provide technical challenges. The current study included 123 individuals with confirmed cases of cholelithiasis who were scheduled to have surgery. The results and discoveries were recorded and scored intraoperatively. The range of possible grades was 0–15. In this case, a score of 5 or below indicated an easy task, 6–10 indicated a moderately difficult task, and 11–15 indicated a very challenging task. Two categories, "Easy" (scores of 5) and "Difficult" (scores of >6), were made for the purpose of statistical analysis. Demographic, clinical, laboratory, and imaging parameters were collected before to surgery and compared to the two intra-operative groups to identify any possible correlations.
Conclusion: 123 patients with cholelithiasis were the subjects of a prospective study. Data from these patients' demographics, imaging, and metabolic profiles, as well as their intra-operative outcomes, were compared. All 123 patients used in the study underwent laparoscopic procedures. Of the 123 cholecystectomies performed laparoscopically, 113 were successful without having to resort to open surgery. In this analysis, we find a conversion rate of 8%. It is 33.3% greater in cases of acute cholecystitis.

Background: Laparoscopic cholecystectomy is minimally invasive surgery done for
removal of diseased gall bladder and considered as gold standard. It is the commonest
general surgical procedures done worldwide.
Methodology: An observational study done in Hind Institute of medical Sciences,
Barabanki. from June 2017 to June 2021 during which patients admitted with the plan
of laparoscopic cholecystectomy were preoperatively evaluated clinically, biochemically
and radiologically. LC was performed by standard 4 port technique was under GA by
qualified surgeon and well-trained team. Surgery was categorised into easy, difficult
and very difficult depending on the duration of surgery. Preoperative factors were then
analysed and compared with the operative difficulty.
Result: A total of 300 patient underwent LC in which 71.7% were females. Mean age of
patients was 41.36±13.68 years with 31.3% patients between 41-49 years. Recurrent
abdominal pain was observed in 38.3% and 4.3% patient had history of biliary
pancreatitis. Ultrasonologically, single stone was observed in 62% whereas thickened
GB wall was observed in 33%. Serum ALP was elevated in 2.3 % whereas 2.7% had
leucocytosis. Operative ease was encountered in 40% consuming < 60 minutes, whereas
56.7% was difficult (60-120 mins) and 3.3 % were very difficult (>120 mins).
Conversion rate was 1.65%, all from very difficult category. Age 40-49 years, solitary
GB calculus, GB wall thickness > 4mm, leucocytosis and history of pancreatitis has
statistically significant correlation with difficult cholecystectomy but no such association
was observed with gender, elevated serum ALP and comorbidities.
Conclusion: Difficult LC was observed in 60% patients. Age between 41-50 years,
solitary GB calculus and thickened GB wall (>4mm) with a attack of pancreatitis can be
considered as predictor for difficult cholecystectomy.

Background: Laparoscopic cholecystectomy is minimally invasive surgery done for removal of diseased gall bladder and considered as gold standard. It is the commonest general surgical procedures done worldwide.
Methodology: An observational study done in Hind Institute of medical Sciences, Barabanki. from June 2017 to June 2021 during which patients admitted with the plan of laparoscopic cholecystectomy were preoperatively evaluated clinically, biochemically and radiologically. LC was performed by standard 4 port technique was under GA by qualified surgeon and well-trained team. Surgery was categorised into easy, difficult and very difficult depending on the duration of surgery. Preoperative factors were then analysed and compared with the operative difficulty.

In India, the incidence of the disease is on the increase due to the change in diet patterns and
the greater awareness of the problems. A gallstones survey limited to railroad workers
conducted in 1966 utilizing oral cholecystography had suggested that gallbladder stones
occurred 7 times more commonly in North Indian workers than in South Indian workers.
Patients were selected according to inclusion and exclusion criteria after taking informed
consent and reassuring them keeping confidentiality of their data. In all the 200 patients,
patients diagnosed as cholelithiasis and who underwent laparoscopiccholecystectomyor
converted to open-cholecystectomywere included in the study. After explaining complete
details of the procedure and complications to the patients, the surgery was performed under
general anesthesia. In our study out of 200 patients, majority of patients, both male and
female had pain as their chief complaints with total percentage of (62%).Next to pain
majority of patients including males (10) and females (16) Nausea as major complaint
constituting (13%) of total average. Dyspepsia 21 i.e., (10.50%), pain + nausea 15 i.e.,
(7.50%) and pain + jaundice 14(7%) as their chief complaints in decreasing order.

Gallstones are composed predominantly of cholesterol, bilirubin and calcium salts with lesser amounts of other constituents. The most popular classification system uses the relative amount of cholesterol as the main criterion and designates gallstones as being either cholesterol or non-cholesterol. The latter are further classified as black or brown pigment stones. A thorough preoperative anaesthetic evaluation was done and patient fitness for general anaesthesia assessed. A dose of antibiotics (usually a cephalosporin) was given 30 minutes before surgery. A nasogastric tube was inserted routinely. The most common indication for open cholecystectomy was symptomatic cholelithiasis (68%). In the laparoscopic group also cholelithiasis (76%) was the most common cause.

Background: Gallstone disease (GSD or Cholelithiasis) is a significant health problem
both worlds over (in both developing and developed nations). The main objective is
Laparoscopic cholecystectomy has rapidly become established as the popular alternative to
open cholecystectomy, but it should have a safety profile better than of open procedure.
Aims and objectives: The aim of this study was to compare conventional cholecystectomy
and laparoscopic cholecystectomy with respect to duration of procedure, complications,
postoperative pain, analgesic requirement and period of hospital stay.
Materials and Methods: This study consists of 52 patients who have undergone gallbladder
removal in GMC Budaun. 26 patients who have undergone laparoscopic cholecystectomy
and 26 patients who have undergone open cholecystectomy for a study period of one year
have been taken into the study In method 52 consecutive patients below 70 years presenting
with calculous cholecystitis with no evidence of CBD stones were randomized to undergo
open and laparoscopic cholecystectomy.
Results: 9 patients of LC and 10 patients of OC were males. Among LC 16 patients were
females and among OC group 15 were females, 28% of patients who underwent open
surgery had complications and 16% of patients who underwent laparoscopic surgery had
complications. The overall percentage of complications is lesser in laparoscopic surgery
than open surgery, The VAS was median grade 2 in LC group as compared to median
grade 4 in LC group. The NSAID’S were used for more days in OC group compared to LC
group, 23 patients who underwent laparoscopic cholecystectomy were discharged before 5
days. All patients who underwent OC stayed >5 days in hospital.
Conclusion: Herewe conclude in results, the duration of pain, rate of complications and
hospital stay were significantly lower in laparoscopic group. However the main advantages
of LC were reduced postoperative pain with less duration of analgesic intake, more rapid
recovery, reduced hospital stay and early return to normal work.