A Clinical study and Management of Cholelithiasis

INTRODUCTION: Among the many distinguished names in Hindu medicine is that of SUSHRUTA, The Father of Indian surger. He compiled the surgical knowledge of his time in his classic ―Sushrata Samhitha. It is believed that this classic was compiled between 800 B.C. and 400 A.D. He described jaundice as-pitta-ashmarijanya‖ meaning a jaundice caused by stone in bile.1It was also known that such jaundice could be caused by wrong diet. 6% of prevelance gall stone was found in India. Diagnosis of gallstone is by proper history and physical examination and combining it with appropriate investigations. With the help of ultrasound we can easily identify gall stones. Because of increase incident of Gall stones and its variable presentations in there is a need for study which can provide prevalence, clinical presentations and management outcomes. AIM OF THE STUDY: 1. To study the age and sex distribution. 2. To study the various modes of presentation. 3. To study safety and efficacy of laparoscopic cholecystectomy in patients of cholelithiasis by comparing with results of open cholecystectomy by comparing use of post-operative analgesia, post-operative hospital stay, wound infection. METHODOLOGY: This dissertation titled as “A clinical study and management of cholelithiasis” is going to conduct at Govt. Royapettah Hospital, KMCH, Chennai-10 for a period of January 2018 to June 2018. About 53 consecutive cases will admit, examine, investigate and operate during the period of January 2018 to June 2018. Detailed history of all the 53 cases will take according to the profoma approved by the guide. Detailed history and examination and relevant investigations done. Risk and complications of the condition as well as surgery has been explain to the patients, concern will take. Preoperative antibiotics will give. In this study sum of the patients undergone open cholecystectomy and some of the patients undergone lap cholecystectomy. Postoperative pain were assessed by VAS. Patients who undergone lap cholecystectomy discharge on the 7th day and open cholecystectomy discharge on the 11th day. Unless any complications. All Patients advise regarding diet, rest and to visit the surgical OPD for regular follow up. In the follow up period attention were given to subject to improvement of the patients with regard to symptoms as well as examination of the operative scar. OBSERVATION: The age incidence of cholelithiasis was more in the 3rd, 4th & 5th decade, with peak incidence in 4th decade of life. 60.4% (32 Patients) were female and 39.6 % (21 Patients) were male. The female to male ratio was 1.52:1. Pain was the commonest presenting symptom presenting in 98% patients. Tenderness in the right hypochondrium was the most common sign present in 100%. The most common complication of cholelithiasis was chronic cholecystitis 80% .LC versus OC (18 cases in open and 35 cases in lap) and found that the mean operating room time was 104 min for OC and 88 min for LC. The conversion rate was 10.5%. The mean duration of hospital stay was 11 days for OC and 8 days for LC. The amount and period of analgesia were significantly less in the LC group. Patients recovered significantly faster after LC. CONCLUSION: The highest age incidence of cholelithiasis was in the 4th decade, even though no age group was exempt from the disease process. The incidence of cholelithiasis was more in females. The commonest symptom was pain and commonest sign was tenderness. The most common complication presenting with symptomatic gall stones was chronic cholecystitis. Laparoscopic cholecystectomy is a safe and effective treatment for most patients with symptomatic gallstones