Gallstone Disease

Dr. Raghavendra C V

Institute of Digestive and Hepatobiliary Sciences

SAKRA WORLD HOSPITAL

Gallstone Disease

• Common clinical problem, has high prevalence

• Presentation

– Asymptomatic

– Symptomatic - Acute/Chronic

– Complications - Empyema, perforation

• Treatment

– Laparoscopic cholecystectomy is the gold standard

Cholecystectomy

• Uncomplicated disease

– Non inflamed gallbladder

– Better delineation of biliovascular anatomy

– Easy dissection

• Complicated disease

– Presence of pus, gangrene of the gallbladder

– Difficult anatomy with potential for bile duct injury

– Longer hospital stay due to sepsis and drain

video

Case Capsule - 1• 66 year old male presented with history of

– severe pain abdomen – 2 days

– Nonbilious vomiting and

– Fever for 2 days

• Status post CABG 2005; He had history of past stone disease complication and required ERC in 2012

• Surgery for Gall bladder deferred in view of cardiac status

• Known diabetic and hypertensive

• On examination, he had mild tachycardia; abdominal examination revealed mild tenderness and guarding RHQ

Evaluation

• Laboratory parameters

– Hb-11.2

– TLC-15800

– Neutrophils-86%

– Serum creatinine-0.95

– LFT:TB-0.8,SGOT-42,SGPT-46,GGT-24,Alb-2.8

– EF-45%

• CT scan

– Inflammed edematous thick walled gall bladder with multiple stones

video

Hospital course

• Lap cholecystectomy done

• Post-operative course-uneventful

• Discharged on POD 3

Case Capsule - 2

• 76 year old male presented with history of

– severe pain abdomen – 15 days

– High coloured urine – 1 week

– Fever for 4 days

• Pateint was out of station and hence continued on medical treatment for the past 10-14

• On examination, he had mild tachycardia; abdominal examination revealed severe tenderness and guarding RHQ

Evaluation

• Laboratory Parameters:

• Hb-12.4

• TC -14,400;

• Serum Creatinine - 1.6 mg%

• LFT :TB-3.4,DB-2.0,SGOT-23,SGPT-15,ALP-133,GGT-75,Alb-2.7

• Amylase-52,Lipase-65

• In view of raised creatinine, MRCP was done which showed distended gall bladder with perforation

Hospital Course

• Laparoscopic partial cholecystectomy + intra op ERCP and CBD stenting done on 6/5/14

• Post op stay uneventful; He had issues related to a urethral stricture with serous drain discharge, requiring a longer hospitalization. Patient discharged in stable state

• HPE : Acute gangrenous cholecystitis with intense edema and fibrinous degeneration of wall

Take home messages

• Complicated gallstone disease is technically challenging and requires good laparoscopy skills and expertise

• Patients are usually elderly with multiple co-morbidities which require specific attention

• Complicated disease can be managed laparoscopically with advanced suturing techniques and combined interventional endoscopic approach

• Early discharge with smooth recovery even in difficult cholecystectomies

THANK YOU