Objective: The study was performed to assess and compare the effect of early (≤ 72 hours) and late (>72 hours) laparoscopic cholecystectomy after Endoscopic retrograde cholangio pancreatography (ERCP) in terms of duration of operation, conversion to open cholecystectomy, intraoperative complicating factors, duration of hospital stay from the date of ERCP, hospital expenses, and presence of postoperative complications. Methods: This is a retrospective study from 2010 up to July 2019. Outcomes (duration of operation, rate of conversion, intraoperative complicating factors, length of hospital stay, hospital expenses and post-operative complications) were compared between patients who had ERCP then cholecystectomy within 72 hours (Early Group) and those who had ERCP then cholecystectomy after more than 72 hours (Late Group). Results: A total of 19 patients were included in this study. There were 10 patients in the Early Group and 9 in the Late Group. Early laparoscopic cholecystectomy after ERCP had a shorter statistically significant duration of hospital. Shorter operative time, fewer intraoperative complicating factors, no conversion to open cholecystectomy, cheaper hospital expenses and no post-operative complications were also noted in the Early Group as compared to the Late Group. Conclusion Early laparoscopic cholecystectomy is safe and results in a shorter hospital stay compared to late laparoscopic cholecystectomy.
Choledocholithiasis ; Cholecystolithiasis

Background and Objective: Understanding the normal anatomy and size of the extrahepatic biliary tree is vital for surgeons to make informed decisions regarding the necessity of additional procedures beyond cholecystectomy. The extrahepatic bile duct (EHBD) comprises the common hepatic duct (CHD) and the common bile duct (CBD), with the former formed by the convergence of the right and left hepatic ducts and the latter extending from the CHD to the duodenum. A normal diameter is indicative of the absence of any signs of obstruction in the EHBD, and the determination of the average range for these ducts are essential for identifying pathologies that may require further surgical intervention. Cholecystolithiasis is a common condition managed at the Philippine General Hospital (PGH). Trans-abdominal ultrasonography is frequently utilized to diagnose cholecystolithiasis, and it can also be used to determine the size of the common bile duct. Knowledge of the normal CBD diameter aids clinicians in distinguishing obstructed bile ducts from normal ones, prompting further diagnostic tests for improved patient management. However, there is limited data on the average diameter of the CBD among Filipino patients with this condition. The study aimed to determine the mean diameter of the common bile duct and common hepatic duct among patients diagnosed with cholecystolithiasis with no signs of obstruction in the EHBD managed at the Philippine General Hospital. Methods: This prospective cross-sectional study included 80 patients who underwent cholecystectomy with intraoperative cholangiography. The CBD and CHD diameters were measured using intraoperative ultrasonography, and the data were analyzed using descriptive statistics and independent t-test. Results: The mean diameter of the CBD was 5.17 mm, with a range of 2.7-10 mm (1.41) mm. The mean diameter of the CHD was 4.71 mm, with a range of 2.3- 10 mm (1.59) mm. There was no significant difference in the CBD and CHD diameters between male and female patients, and across different age groups. Conclusion In patients with cholecystolithiasis managed at the PGH, the mean diameter of the CBD and the CHD was 5.17 mm and 4.71 mm, respectively, with no significant difference between genders and age groups. The mean diameter of the CBD among Filipino patients with cholecystolithiasis is similar to those reported in other countries. These findings may have clinical implications for the management of patients with cholecystolithiasis, particularly in the planning of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy. Further studies with larger sample sizes and different populations are recommended to validate these results. These findings can aid clinicians in determining the need for pre-operative Magnetic Resonance Cholangiopancreatography (MRCP) or selective intraoperative cholangiography to detect extrahepatic bile duct obstruction.
Common Bile Duct ; Cholecystolithiasis

Ceftriaxone is a commonly used antibiotic due to some of its advantages. Reversible gallbladder (GB) sludge or stone has been reported after ceftriaxone therapy. Most of these patients have no symptom, but the GB sludge or stone can sometimes cause cholecystitis. We experienced two patients who had newly developed GB stones after ceftriaxone therapy for diverticulitis and pneumonia, and this resolved spontaneously 1 month after discontinuation of the drug. Awareness of this complication could help to prevent unnecessary cholecystectomy.
Ceftriaxone ; Cholecystectomy ; Cholecystitis ; Cholecystolithiasis ; Diverticulitis ; Gallbladder ; Gallstones ; Humans ; Pneumonia ; Sewage ; Young Adult

PURPOSE: South Korea has a high prevalence of gallstones, the type of which could be influenced by changes in diet and socioeconomic status. Here we aimed to investigate the epidemiological characteristics and changing patterns of gallstones over the past 20 years in Korea. METHODS: A total of 5,808 patients who underwent cholecystectomy due to gallstones at Seoul National University Hospital between 1996 and 2015 were analyzed. Patients were divided into 4 subgroups: period 1 (1996–2000, n = 792), period 2 (2001–2005, n = 1,215), period 3 (2006–2010, n = 1,525), period 4 (2011–2015, n = 2,276). Gallstones were classified by type: pure cholesterol (PC), mixed cholesterol (MC), calcium bilirubinate (CB), black pigment (BP), and combination (COM). RESULTS: The female to male ratio was 1.16 with mean ages of 53.6 and 55.3 years old, respectively. The ratio of cholesterol stones to pigment stones was 0.96:1. The mean age and male to female ratio of the patients increased over time. The proportion of cholesterol vs pigment stone did not differ significantly. Proportions of PC and MC stone subtypes did not change notably, whereas proportion of BP stones increased (34.0% to 45.5%), and CB stones decreased (20.7% to 5.3%). CONCLUSION: Gallstone types and occurrences were affected by environmental changes, and pigment stones remained common in Korea. Although no distinct increase in cholesterol stones was noted, the proportion of CB stones decreased. As the mean age at gallstone presentation increases, BP stones could become more prevalent.
Bilirubin ; Cholecystectomy ; Cholecystolithiasis ; Cholelithiasis ; Cholesterol ; Classification ; Diet ; Female ; Gallstones ; Humans ; Korea ; Male ; Prevalence ; Seoul ; Social Class

Background: Gallstone is a common disease not only in Vietnam but worldwide. A method of treatment for gallstone has not been discovered. Cholecystectomy is the main method for cholecystolithiasis. This solution has some advantage but the weak point is it can result in injury to the bile duct, high cost and cholecystectomy is not able to be carried out in every hospital. The particular traits of the Vietnamese gallstone patients are mixed crystals. Modern Medicine has some drugs for cholesterol stone so it has little affect. In addition, it gives undesirable side effects. Objective: To evaluate the effectiveness of the granulated medicine TSM in the treatment of cholecystolithiasis and biliary sludge. Subject and Method: The study was carried out in 47 cases (35 cholecystolithiasis, 12 biliary sludge) that used granulated TSM. Result: Granulated TSM reduce some clinical symptoms in gallstone patients with p<0.01. In general, the granulated TSM did not cause side effects and did not affect the liver and kidney functions. Conclusion: Granulated TSM has an advantage for gallstone patients. Gallstones were eliminated and completely in some cases.
Cholecystolithiasis ; biliary sludge ; granulated medicine TSM

BACKGROUND/AIMS: Published studies suggest that socioeconomic factors contribute to increasing cholecystectomy rates for biliary dyskinesia (BD). The aim of this study was to identify factors driving admissions and operations for BD by examining regional variability in hospitalizations and cholecystectomies for this disorder. METHODS: Annual hospitalizations and cholecystectomy rates for biliary diseases were assessed using the State Inpatient Databases of the Agency for Healthcare Research and Quality based on diagnosis codes for biliary dyskinesia, cholecystolithiasis and cholecystitis. RESULTS: Annual admissions for BD varied nearly sevenfold among different states within the United States. Hospitalizations for gallstone disease and its complication showed less variability, differing 2-fold between states. Nearly 70% of admissions for BD and about 85% of admissions for gallstone disease resulted in cholecystectomies. Higher admission rates for BD were best predicted by high overall hospitalization rates, admission rate for gallstone disease and the physician workforce within a state. Cholecystectomy rates for BD were higher in states with low population density and high rates of cholecystectomy for gallstone disease. CONCLUSIONS: These data suggest that established medical practice patterns significantly contribute to the variability in admissions and operations for biliary dyskinesia. The findings also indicate that lower thresholds for operative interventions are an important determinant in the approach to this disorder. Considering the benign course of functional illnesses, the bar for surgical interventions should be raised rather than lowered; in addition active conservative treatment options should be developed for these patients.
Biliary Dyskinesia ; Cholecystectomy ; Cholecystolithiasis ; Delivery of Health Care ; Gallstones ; Gastrointestinal Diseases ; Health Services Research ; Hospitalization ; Humans ; Inpatients ; Population Density ; Socioeconomic Factors ; United States

PURPOSE: Although an increased incidence of gallbladder (GB) stone formation after gastrectomy has been reported, its etiology remains uncertain. The goal of this study was to explore the incidence of gallstone formation after gastrectomy in gastric cancer patients and investigate the risk factors therein.MATERIALS AND METHODS: Medical records of patients who underwent curative gastrectomy, performed by a single surgeon between August 2012 and December 2015 at the Asan Medical Center, were retrospectively reviewed. Baseline characteristics and surgical outcomes, including GB stone gallstone formation after gastrectomy, were analyzed.RESULTS: Of 561 patients included in the study, 36 presented with GB stone formation after gastrectomy for gastric cancer. The incidence of gallstone formation was 6.4%. The mean interval between gallstone formation and gastrectomy was 21.9 months. In multivariate analyses, the incidence of gallstone formation increased in patients 63 years or older, with greater than 6.2 kg weight loss in the first 6 months after the procedure, a preoperative serum total bilirubin level greater than 0.5 mg/dL, and in patients who did not receive adjuvant chemotherapy.CONCLUSIONS: This study presented risk factors for GB stone formation after gastric cancer surgery, and special attention should be afforded to patients with such risk factors.
Bilirubin ; Chemotherapy, Adjuvant ; Cholecystolithiasis ; Chungcheongnam-do ; Gallbladder ; Gallstones ; Gastrectomy ; Humans ; Incidence ; Medical Records ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Stomach Neoplasms ; Weight Loss

PURPOSE: To validate the use of harmonic ultrasonography (US) in the detection of gallbladder microlithiasis. METHODS: From November 30, 2012, to January 18, 2014, fundamental US (FUS) and harmonic US with a high background noise (HUS-N) were performed for evaluation of gallbladder during the routine abdomen US. During the US, a dot-like stone (or stones) with Brownian motion was regarded as a positive finding of microlithiasis. Fifty-five patients with microlithiasis in the gallbladder detected on US were enrolled as the subjects of a retrospective review. With respect to the obtained images, two abdominal radiologists independently scored the conspicuity of gallbladder microlithiasis on FUS and HUS-N by using a 4-grade scale. The statistical analysis employed a kappa test and a Wilcoxon rank-sum test. RESULTS: For FUS, the conspicuity grades of gallbladder microlithiasis were G1 in 25 and 37, G2 in 21 and 9, G3 in 6 and 6, G4 in 3 and 3 patients, while HUS-N showed G1 in 0 and 0, G2 in 3 and 2, G3 in 12 and 15, and G4 in 40 and 38 patients, respectively, by each of the two radiologists. The kappa value was 0.633 for FUS between the two radiologists and 0.708 for HUS-N. HUS-N showed better conspicuity of gallbladder microlithiasis than FUS with significant P-values of less than 0.001 and 0.001 for the two radiologists, respectively. CONCLUSION: Compared with FUS, HUS-N enables better detection of microlithiasis in the gallbladder.
Abdomen ; Cholecystolithiasis ; Gallbladder* ; Humans ; Noise ; Retrospective Studies ; Ultrasonography*

Cholecystolithiasis ; complications ; Humans ; Hypertension, Portal ; Portal Vein ; pathology

BACKGROUND/AIMS: The aim of this study is to investigate the reflux patterns in patients with galbladder stone and the change of reflux patterns after cholecystectomy in such patients. METHODS: Fourteen patients with cholecystolithiasis and a control group including 10 healthy control subjects were enrolled in this prospective study. Demographical findings, reflux symptom score scale and 24-hour impedance pH values of the 14 cholecystolithiasis cases and the control group were evaluated. The impedance pH study was repeated 3 months after cholecystectomy. RESULTS: Age, gender, and BMI were not different between the two groups. Total and supine weakly alkaline reflux time (%) (1.0 vs 22.5, P = 0.028; 201.85 vs 9.65, P = 0.012), the longest episodes of total, upright and supine weakly alkaline reflux mediums (11 vs 2, P = 0.025; 8.5 vs 1.0, P = 0.035; 3 vs 0, P = 0.027), total and supine weakly alkaline reflux time in minutes (287.35 vs 75.10, P = 0.022; 62.5 vs 1.4, P = 0.017), the number of alkaline reflux episodes (162.5 vs 72.5, P = 0.022) were decreased with statistical significance. No statistically significant difference was found in the comparison of symptoms between the subjects in the control group and the patients with cholecystolithiasis, in preoperative, postoperative and postcholecystectomy status. CONCLUSIONS: Significant reflux symptoms did not occur after cholecystectomy. Post cholecystectomy weakly alkaline reflux was decreased, but it was determined that acid reflux increased after cholecystectomy by impedance pH-metry in the study group.
Cholecystectomy ; Cholecystolithiasis ; Electric Impedance ; Gastroesophageal Reflux ; Humans ; Hydrogen-Ion Concentration ; Prospective Studies