Surgical practice in symptomatic and asymptomatic gallstone disease

AIMS

To determine the surgical practice in individuals with symptomatic and asymptomatic gallstone disease using a questionnaire survey.

METHODS

A questionnaire was sent to 724 patients with gallstone disease. Details of symptoms, duration of illness, nature of treatment including surgery, color of gallstones retrieved and postoperative follow-up particulars were obtained.

RESULTS

The study group included 225 (54%) men; there was a rising trend of prevalence of gallstones in men with increasing age (p<0.05). A third of the patients (142 [34%]) were symptomatic. The mean duration of symptoms was 12.1 months. One hundred and ninety seven patients (48%), including 90 asymptomatic ones, underwent cholecystectomy. Most patients (92.5% of those symptomatic and 76.6% of those asymptomatic) underwent cholecystectomy within one year of diagnosis. Eight asymptomatic patients underwent surgery 3 years or more after diagnosis. The predominant color of stones retrieved was black or brown (57%) or mixed (39%).

CONCLUSIONS

A majority of patients with gallstone disease had cholecystectomy within one year of diagnosis. Black or brown pigment stones were the dominant types of gallstones.

Predicting the composition of gallstones by infrared spectroscopy

AIM

To determine the composition of gallstones in South India by comparing visual assessment with graphic interpretation of infrared spectra.

METHODS

Infrared spectroscopy (IRS) was used in qualitative analysis of 168 gallstones from Tamilnadu, Kerala and Karnataka and compared with visual interpretation. The spectrum of cholesterol, calcium bilirubinate and calcium carbonate for each stone was correlated with visual inspection.

RESULTS

Fifty four percent of gallstones were of pigment variety, 43% were of mixed and the remaining 3% were cholesterol gallstones as categorised by visual interpretation. Based on infrared spectrocopic interpretation the percentages were 58%, 39% and 2% respectively. There was a good agreement between the visual inspection and IRS in classification of gallstones (Kappa value 85%; 95% CI 77-93%).

CONCLUSION

Visual inspection of gallstones can predict the composition of gallstone with good accuracy and was comparable to infrared spectroscopic interpretation.

Composition of gallstones in Coimbatore District of Tamil Nadu State

BACKGROUND

Gallstones in northern India are predominantly of the cholesterol type; such information on gallstones in southern India is scant.

AIM

To analyze the composition of gallstones from patients residing in Coimbatore District in Tamil Nadu State.

METHODS

The stones were classified using the Bernhoft criteria and was correlated with the morphological characteristics.

RESULTS

Of the 105 gallstones analyzed, 67 (63.8%) were of the pigment variety and 36 (34.8%) of the intermediate/mixed type. There were only two cholesterol stones. The mean proportions of cholesterol, bilirubin and calcium in the pigment and intermediate stones were 7.1%, 26.1% and 7.8% and 30.2%, 18.4% and 6.3%, respectively. The mean proportion of bilirubin in the pigment stones was higher than in the intermediate type. Morphologically, pigment stones were black in 55% and amorphous in 63%; the intermediate stones were hard in 50% and of variegated color ranging from yellow to ivory white in 61%; both cholesterol stones were multiple, hard and brown.

CONCLUSIONS

There is a predominance of pigment and intermediate gallstones (98%) in this district. These stones have reduced cholesterol and an increase in bilirubin and calcium proportions.

Is vegetarianism a precipitating factor for gallstones in cirrhotics?

AIM

To study the association of factors such as alcohol, smoking and vegetarianism with presence of gallstones amongst cirrhotics.

PATIENTS AND METHODS

Data on alcoholism, smoking and vegetarianism was collected from the case records of 669 cirrhotics with (76) or without gallstones (593) retrospectively. Relative risk for the factors was computed individually and in combination controlling for the effects of alcoholism and smoking on vegetarianism.

RESULTS

Alcoholism and smoking were of low relative risk [R.R-1.27 (95% CI 0.82 to 1.96), and 1.02 (95% CI 0.65 to 1.61) respectively] while vegetarianism was associated with high risk for gallstone formation in cirrhotics [R.R 2.74 (95% CI 1.65-4.53)]. Vegetarian men had a relative risk of 3.02 (95% CI 1.75-5.22) irrespective of their alcoholic status. If women were alcoholic the relative risk increased to 7.03 (95% CI 3.26-15.12). Controlling for effects of gender and alcoholism, vegetarian cirrhotics had a 3 times greater risk for gallstone formation [Mantel Haenszel Relative Risk 3.18 (95% CI MHRR 1.82-5.56)].

CONCLUSIONS

Cirrhotic, vegetarian women in South India have a much higher risk for gallstones, if they are alcoholic. Alcoholic men who are vegetarians are at a greater risk for gallstone disease.