Abstract

A CLINICAL STUDY OF GALL STONE DISEASE

Author(s): K. Lokesh1, Srideep Siddavaram2

BACKGROUND
Gallbladder disorders rank among the most common and costly of all digestive system diseases. This disease is more common in Western world. Prevalence rates vary from 15– 25% in developed countries. In India, it varies from 5 – 10%. Incidence of cholelithiasis is increasing considerably in India, possibly due to change in the dietary habits, which is becoming westernized and changing life style. Northern India show 7 times more incidence than that in southern parts. Because of the extensive studies on aetiology of gallstones, better understanding of the pathogenesis in the past two decades, the management has become more appropriate and effective. The operations on biliary tree and gall bladder rank next only to hernia repair and appendicectomy. Minimally invasive surgery improves patient’s compliance and reduces morbidity rates.
The objectives of this study were-
1. To study age and sex distribution, various types of clinical presentations in patients with gall stone disease,
2. To study the bacteriology of the bile collected from all cholecystectomy cases and
3. To determine the composition of gallstones removed from patients.
MATERIALS AND METHODS
Study Type- Prospective observational study, Study Setting- Department of General surgery, Narayana medical college and Hospital. Study Period- Study is done from November 2014 to October 2016. Study sample: 100 cases of clearly documented gall stones on USG abdomen. Inclusion Criteria- Patient aged > 11 years and <70 years, All patients of gallstone disease who got admitted to the hospital and who underwent cholecystectomy either open or laparoscopic procedures. Exclusion Criteria- Acalculous cholecystitis, Primary CBD stones. Method of Study- A detailed history of demographic data, clinical presentation, complications if any, and previous treatment are recorded in a proforma. Thorough clinical examination was done in them and was subjected to investigations. Relevant preoperative investigations like blood routine, Urine, Plain X-ray abdomen and USG were done in all cases. All cases underwent open or laparoscopic cholecystectomy under epidural or general anaesthesia. Intra operative findings, operative time is noted. Bile and gallstones are collected from removed gall bladder and was sent for culture and morphological analysis respectively. Specimen is subjected to histopathological examination.
RESULTS
In this series, age varies from 11 to 70 years. 3 patients (3%) were in the age group 11 - 20 years, 11 patients (11%) were in the 21- 30 age group, 26(26%) were between 31 – 40 years, 26 (26%) were in the age group between 41 - 50 years, 23 (23%) were in the age group 51 - 60 of age group and 11 (11%) were between 61 – 70 years. In the study, maximum number of cases is seen in 4th and 5th decade of life amounting for more than 50% of cases.
CONCLUSION
From our study, we concluded that symptomatic gallstone diseases were more common in 5th and 6th decade of life with a female predominance. Common presentation in symptomatic gallbladder is pain abdomen. Ultrasound was effective in diagnosing gallstones in all the patients in our series. Proper case selection decreases the conversion rate from lap to open surgery. In the present series majority of the cases showed positive bile culture, of which E. coli was the most common organism isolated. Multiple, mixed stones were the most common type of stone identified. All gallbladders removed for gallstone disease should be subjected for histopathology; to exclude gallbladder malignancy as significant pathology may be present with normal gross morphology.