Objective To explore the feasibility and precautions of small incision bile duct stone removal in primary hospitals in extremely high-altitude areas.Methods The experience of small incision biliary exploration and cholecystectomy under general anesthesia at primary hospitals during the author's medical aid to Xizang in the high-altitude areas of northern Xizang was summarized(from June 2022 to December 2022).Results A total of 11 cases of small incision common bile duct stone removal were completed.Abdominal drainage was performed in all patients,including 6 cases with T-shaped tubes and 5 cases with primary closure of the common bile duct.The patients recovered well after surgery and was discharged.Conclusion In extreme high-altitude areas,under the guidance of medical aid doctors,it is completely feasible for primary hospitals to carry out small incision bile duct stone removal by selecting appropriate cases,training surgical skills,and performing detailed preoperative preparation.

Objective To investigate the diarrhea after minilaparotomy cholecystectomy among Tibetan residents in extremely high-altitude areas.Methods A retrospective analysis was conducted on the clinical data of 71 patients who underwent small incision cholecystectomy at the County People's Hospital during the period of medical aid(from June 2022 to December 2022).There were 38 patients(53.52%)with postoperative diarrhea and 33 patients(46.48%)without diarrhea.Results The duration of diarrhea was less than 1 week in 8 patients,ranged from 1 week to 3 months in 21 patients,and lasted for more than 3 months in 9 patients.There were significant differences between the two groups in terms of age(P<0.000 1),body mass index(P<0.000 1),proportions of patients with liver cirrhosis(P=0.012 9),history of acute cholecystitis(P=0.002 1),history of coronary heart disease(P=0.040 7),and presence of tenderness in the right upper abdomen during admission(P<0.000 1),white blood cell count(P=0.007 0),alanine aminotransferase(P=0.047 3),gallbladder diameter(P=0.003 4),gallbladder wall thickness(P=0.000 4),surgical duration(P=0.004 7),postoperative antibiotic use(P=0.000 6),postoperative hospital stay(P=0.000 2),and immediate resumption of butter tea(P<0.000 1).Age and immediate resumption of butter tea after surgery were independent risk factors for diarrhea after minilaparotomy cholecystectomy.Conclusion There is a higher incidence of diarrhea following small incision cholecystectomy in the residents of extremely high-altitude areas,which is associated with various factors such as the environment and lifestyle of the region.It is essential to enhance health education on gallstone and cultivate good personal health habits.Clinicians should conduct a detailed preoperative assessment.Patients should avoid drinking butter tea during perioperative period to avoid postoperative diarrhea.