International Journal of Surgery Science 2019; 3(3): 05-08

E-ISSN: 2616-3470
P-ISSN: 2616-3462
© Surgery Science Cholelithiasis presentation and management in tertiary
www.surgeryscience.com
2019; 3(3): 05-08 care hospital in South India: A clinical study
Received: 04-05-2019
Accepted: 08-06-2019
Deepak Naik P, Harish Kumar P and Lokesh MG
Deepak Naik P
Department of General Surgery,
JSS Medical College Mysuru,
DOI: https://doi.org/10.33545/surgery.2019.v3.i3a.02
Karnataka, India
Abstract
Harish Kumar P Background: Gallstones are the major cause of morbidity and mortality throughout the world. With at
Department of General Surgery, least 10 % of the adults have gallstones with a recent rise in the incidence due to change in the dietary
JSS Medical College Mysuru, factors. This study intends to know its various modes of presentation, treatment, outcome.
Karnataka, India Methods: Fifty patients with symptoms and signs of cholelithiasis admitted in surgical ‘B’ unit,
Government Medical College - A Tertiary care hospital, Mysuru from period of January 2012 to July 2013,
Lokesh MG were included in the study, clinical profile, investigation, treatments, outcomes were analysed.
Department of General Surgery, Results: The highest age incidence of cholelithiasis was in the 5th decade, more common in females. Pain
MMC & RI, Mysuru, Karnataka,
abdomen was the most common symptom. Ultrasonography showed gallbladder stones in all patients and
India
52% of patients undergone open cholecystectomy, 48% of patients undergone laparoscopic
cholecystectomy. The conversion rate of lap to open cholecystectomy was 4%. The operating room time
and the length of post-operative stay were 65 min and 7 days in open cholecystectomy and 115 min and 3
days in lap cholecystectomy.
Conclusions: The result showed cholelithiasis was more common in females, 5 th decade, presented most
commonly with pain abdomen. Ultrasonography was the most common investigation. Laparoscopic
cholecystectomy reduces the number of hospital days, pain, disability.

Keywords: Cholelithiasis; ultrasonography; cholecystectomy, laparoscopic cholecystyectomy

Introduction
The prevalence of gall bladder stones varies widely in different parts of the world. In India
estimated to be around 4% whereas in western world it is 10% [1].
Gallstones in patients without biliary symptoms are commonly diagnosed incidentally on
ultrasonography, CT scans, abdominal radiography, or at laparotomy. Several studies have
examined the likelihood of developing biliary colic or developing significant complications of
gallstone disease. Approximately 3% of asymptomatic individuals become symptomatic per year
(i.e., develop biliary colic). Once symptomatic, patients tend to have recurring bouts of biliary
colic. Complicated gallstone disease develops in 3 to 5% of symptomatic patients per year. Over
a 20-year period, about two thirds of asymptomatic patients with gallstones remain symptom
free [2].
A Ultrasound (US) is the simplest and most reliable method for diagnosis of Gallstones [3].
In addition to identifying stones within the gallbladder or bile duct, abdominal ultrasonography
provides important ancillary information regarding the anatomy of bile ducts, pancreas, and
other structures in the upper abdomen [4].
Laparoscopic cholecystectomy has become widely used since it was first performed in 1988.
The evaluation and treatment of suspected stones in the common bile duct can be carried out by
endoscopic retrograde cholangiopancreatography before laparoscopic cholecystectomy [5].
Open Cholecystectomy, Throughout this century, operative cholecystectomy has been the gold
standard of treatment for gallstones. The greatest drawbacks to open cholecystectomy are the
resulting pain and weeks of disability [6].

Correspondence Methods
Harish Kumar P Fifty patients with symptoms and signs of cholelithiasis admitted in surgical ‘B’ unit,
Department of General Surgery, Government Medical College - A Tertiary care hospital, Mysuru from period of January 2012 to
JSS Medical College Mysuru,
Karnataka, India
July 2013, were included in the study, clinical profile, investigation, treatments, outcomes were

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analysed. Data collected in predesigned proforma, regarding haemoglobin level. 2 cases diagnosed as acute Cholecystitis
Patient Biodata, presenting complaints, preoperative were managed conservatively with IV fluids, nasogastric
intraoperative and post-operative analysis. Inclusion criteria all aspiration, antibiotics, and analgesics. These patients were
patients age >18 years, Exclusion criteria was patient unfit for treated conservatively and were then offered surgery after 6
Anaesthesia and surgery, those patients ultrasound detected or weeks. Associated medical illness was treated accordingly
suspected CBD stones and those patients not willing to before taking the patient to surgery.
participate in study.
All 50 patients underwent USG abdomen, baseline Type of operation
investigations were done in all 50 patients.
Table 5: Type of operation
Results Type of operation Number of cases Percentage (%)
In our study there is an increased incidence of cholelithiasis in Laparoscopic cholecystectomy 25 50
the 5th and 6th decade with the peak in the 5th decade. In our Open cholecystectomy 25 50
study the youngest patient was 19 years old and the oldest
patient is 75 years old. In our study 25 patients underwent laparoscopic
cholecystectomy and 25 patients undergone open
Table 1: Distribution of cases by age group
cholecystectomy.
Age group (years) Number of cases Percentage (%)
11-20 1 2 Incision for open cholecystectomy
21-30 3 10
31-40 5 18 Table 6: Type of incision for open cholecystectomy
41-50 17 34
51-60 11 22 Type of incision Number of cases
>60 7 14 Right subcostal 20
Right paramedian 3
Table 2: Sex-wise distribution Right transverse 2
Upper midline 0
Sex Number of cases Percentage (%)
Male 20 40
Female 30 60 Operation
Total 50 100
Table 7: Operating room time
In our study 30 patients were female and 20 patients were male. Type of operation Operating room time
The present study shows gallstones diseases are a common Laparoscopic cholecystectomy 55 min
problem in female population. The female to male ratio is 3:2. Open cholecystectomy 110 min

Presenting symptoms The operating room time for open cholecystectomy was 55 min
and lap cholecystectomy was 110 min
Table 3: Presenting symptoms
Symptoms Number of cases Percentage (%) Complications
Pain 49 98 Intraoperative complications
Nausea/vomiting 28 56
Jaundice 7 14 Table 8: Intra operative complications
Dyspepsia 12 24 Intra operative Laparoscopic Open
Fever 4 8
complication cholecystectomy cholecystectomy
Bile duct injury 1 1
Ultrasound findings
In the present study 3 patients had wound infection. 1 patient
Table 4: Ultrasound findings
had post-operative bile leak which was managed conservatively
Ultrasound findings Number of cases Percentage (%) and patient recovered. Two patients had bile duct injury which
Stones in gallbladder 50 100 was repaired on the T-tube.
Solitary stone 12 24
Multiple stones 38 76 Table 9: Postoperative complications
Thickening of gallbladder 40 80
Mass 4 8 Postoperative Laparoscopic Open
Total
complications cholecystectomy cholecystectomy
Wound infection 1 2 3
Ultrasound scanning of the abdomen was done in all patients. 43
Haemorrhage 0 0 0
patients had stone in gallbladder, 40 patients had thickening of
Retained stones 0 0 0
Gall bladder. Bile leak 0 1 1
Prolong ileus 0 0 0
Preoperative evaluation
A haemoglobin level of 10 gm/dl was accepted for the surgery. Duration of hospital stay
Blood transfusion was given to selected patients to improve the

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Table 10: Duration of hospital stay Comparison of presenting symptoms with other studies
Operation Length of stay (days) Pain was the predominant symptoms in the present study with
Open cholecystectomy 7 98%. The commonest site of pain was in the Rt.
Lap cholecystectomy 3 Hypochondrium, and the next commonest site was Epigastria. 5
patients complained of pain radiating to the back. 48 patients
Postoperative length of stay was 7 days for open had chronic Recurring pain, 2 patients had acute onset of pain,
cholecystectomy and 3 days for lap cholecystectomy. pain was colicky in nature. 13 patients had dull aching pain, 33
patients had Colicky pain. Similar presentations were noted in
Types of stones the series of Alok Sharma, Ganey et al. series [11], Goswitz et al.
series [12].
Table 11: Type of stones 56% (28 patients) of cases in the present series had
nausea/vomiting. Patients vomiting was spontaneous, occurred
Type of stone Number of cases Percentage mostly during the attack of pain.
Cholesterol stone 4 8
The incidence of dyspepsia in present series was similar to
Mixed stones 45 90
Ganey series, Alok Sharma series [10]. Fever was present in 4
Pigment stones 1 2
cases in the present study. Fever was secondary to cholangitis
due to biliary obstruction.
Discussion
The incidence of dyspepsia in present series was similar to
In our study 50 cases of Cholelithiasis that were admitted in
Ganey series, Alok Sharma series. Fever was present in 4 cases
surgical ‘B’ unit, Government Medical College - A Tertiary care
in the present study. Fever was secondary to cholangitis due to
hospital, Mysuru from period of January 2012 to July 2013,
biliary obstruction.
Well known available literature on Cholelithiasis is reviewed.
The results of our study are compared with those of well- known
Table 14: Comparison of presenting symptoms with other studies
authors.
After a detailed history, clinical investigations and available Present Alok Sharma Ganey’s
treatment following observations were noted. Symptoms study series series
No. % No. % No. %
Age incidence Pain 49 98 58 100 987 95
Nausea/vomiting 28 56 48 82.8 576 55.6
Table 12: Comparison of age incidence with other studies Jaundice 7 14 3 5.17 101 10
Dyspepsia 12 24 5 8.62 222 21
Present Herman’s Rushad’s Fever 4 8 Na Na 92 9
Age group
study series series
(years)
No. % No. % No. % Ultrasound findings
11-20 1 2 25 1.6 0 0 Ultrasound scanning was done in all patients, all the cases
21-30 5 10 92 5.9 4 3.33 revealed stone in the gall bladder. Gall bladder stones were seen
31-40 9 18 226 14.6 36 36.30
in 50 patients.
41-50 17 34 325 21.0 30 25.0
Out of which 12 were solitary stones, 38 were multiple,
51-60 11 22 473 30.6 29 24.16
>60 7 14 352 23.5 21 17.5
thickening of gall bladder was seen in 40 patients, mass detected
in 4 patients.
Age incidence
Table 15: Comparison of ultrasound findings with other study
In this study, cases fall between 19 and 75 years.
There is an increased incidence in the 5th and 6th decade with the Ultrasound findings
Present study Alok Sharma series
maximum incidence in the 5th decade. Similar incidence is seen No. % No. %
in the studies of Herman et al. (5th decade) [7]. Stones in gallbladder 50 100 57 98.3
Solitary stone 12 24 15 26.3
Sex distribution Multiple stones 38 76 42 73.7
Thickening of gallbladder 40 80 10 17.2
Table 13: Comparison of sex distribution with other studies Mass 4 8 1 1.7

Present Battacharya’s Alok Sharma Ultrasound scanning was done in all patients, all the cases
Sex study series series revealed stone in the gall bladder. Gall bladder stones were seen
No. % No. % No. % in 50 patients. Out of which 12 were solitary stones, 38 were
Male 20 40 26 28.6 41 70
multiple, and thickening of gall bladder was seen in 40 patients,
Female 30 60 65 71.4 17 30
mass detected in 4 patients. Many of the features in my study
Total 50 100 91 100 58 100
were similar to studies of Major Alok Sharma et al [10].
Sex distribution
In the present study 30 out of 50 cases were female while the Preoperative evaluation
A haemoglobin level of 10 Gms was accepted for the surgery.
rest 20 were male. Battacharya [8] series showed 71.4% were
Blood transfusion was given to selected patients to improve the
female, 28.6% were male.
haemoglobin level. 2 cases diagnosed as acute Cholecystitis
Similar sex preponderance in the favour of females were noted
were managed conservatively with IV fluids, nasogastric
by Tamhankar AP [9], and Major Alok Sharma et al. [10], series
aspiration, antibiotics, and analgesics. These patients were
showed that 70% were male and 30% were female.
treated conservatively and were then offered surgery after 6
weeks. Associated medical illness was treated accordingly

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and the patient improved. In this case drain was removed on the
7th day.

Follow up
There was no problem in the follow up period in any patient.
Nothing more can be stated because of limited period of follow
up of patients.

Acknowledgements
Declarations
Funding: None

Conflict of interest: Authors declare no conflict of interest

Ethical approval: institution ethical committee approved

References
1. Tandon R. Diseases of Gall Bladder and Biliary Tract. In:
API Textbook of Medicine, Shah SN, ed. 9th ed. Mumbai:
API Publications, 2012, 911.

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