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Gallbladder adenomyoma/adenomyomatous nodule/adenomyomatosis is a benign condition characterized by mucosal invaginations within the gallbladder wall with or without proliferation of smooth muscle fibers. Gallbladder adenomyoma is often asymptomatic and discovered incidentally during imaging studies performed for other unrelated conditions. It can mimic malignancy on radiological findings, creating a diagnostic dilemma. The management and outcome of adenomyoma and malignant lesions of gallbladder are completely different. We present here a rare case of 52-year-old female diagnosed with gallbladder adenomyoma in histopathological examination highlighting the insights into this benign distinctive condition. Therefore, it is essential to completely understand the pathognomonic and histopathological features of gallbladder adenomyoma in order to accurately diagnose this condition., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, B. et al.)

Intracholecystic papillary neoplasm (ICPN) is a mass-forming, noninvasive epithelial premalignant neoplasm arising from the gallbladder mucosal lining and projecting into the lumen of the gallbladder. It is potentially fatal and if left untreated can progress to invasive gallbladder carcinoma. Incidentally ICPN is found on imaging or during postoperative histological evaluation and is likely to be missed preoperatively. We present a rare case of ICPN in a 70-year-old female patient who was admitted with complaints of pain in the right hypochondrium since one month and was postoperatively diagnosed with ICPN through histopathological examination. We discuss the need for early intervention in gallbladder polypoidal masses to prevent the conversion of benign or preinvasive tumors to malignancy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Bargaje et al.)

Carcinoma of the gallbladder is an uncommon malignancy with a poor prognosis overall. Histologically, adenocarcinoma is the most common type of gallbladder carcinoma. Adenosquamous carcinoma is a rare histological type of gallbladder carcinoma comprising both the glandular and squamous elements. Adenosquamous carcinoma shows more aggressive behavior than adenocarcinomas and is often detected in a late advanced stage. Treatment is usually extended surgical resection but has a poor prognosis. We present a rare case of adenosquamous carcinoma with lymphovascular invasion in a 72-year-old male who was managed with extended cholecystectomy., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Khanal et al.)

Introduction Cholecystectomy, the surgical removal of the gallbladder, is a common procedure worldwide. Despite no visible anomalies, routine histopathological examination (HPE) of gallbladder specimens post-surgery is standard practice to exclude pathologies, notably gallbladder cancer (GBC). Incidence rates of GBC vary geographically and ethnically. Surgical intervention is recommended for advanced GBC stages, while early stages may require cholecystectomy alone. Although rare, GBC and bile duct cancers pose increased risks in certain demographics, such as women and individuals over 65. Routine HPE practices vary globally based on resource availability and GBC incidence. This study assesses the necessity of routine HPE by evaluating the selective processing of gallbladder specimens suspected of GBC, prioritizing patient safety. Materials and methods This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine HPE for excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC) outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators. Results Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to HPE post-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited GBC; however, 3.3% (9) displayed premalignant histopathological features in their specimens. Conclusion In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo HPE, seems prudent, especially in regions with low GBC incidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Jamal et al.)

Cholecystectomy is commonly performed to address gallstone diseases, including the development of gallstones, which can lead to symptoms such as nausea, vomiting, and abdominal pain. Bile acids (BAs) produced by the liver are primarily stored and concentrated in the gallbladder (GB). After cholecystectomy, the body's ability to digest lipids is reduced due to the absence of the GB. Post-cholecystectomy syndrome (PCS) can occur when abdominal symptoms manifest after surgery. The purpose of this review is to look at the various effects of different dietary factors on patients undergoing cholecystectomy, how they affect their overall health after surgery, and how they contribute to symptoms of PCS. Some individuals may experience mild discomfort or alterations in bowel patterns, especially after consuming high-fat meals. The findings from the conducted studies suggest that, although dietary changes are a common recommendation, these measures are not sufficiently supported by evidence when it comes to alleviating symptoms and improving outcomes post-cholecystectomy. The studies found that subjects who consumed particular foods, such as processed meat and fried fatty foods, had exacerbated symptoms after cholecystectomy. Further studies are still required to understand the precise food factors that might affect post-surgical symptoms, as well as outcomes, and to develop tailored measures to enhance patient care and long-term prognosis after undergoing cholecystectomy., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Dahmiwal et al.)

Objective Our goal is to describe and report the outcomes of patients undergoing robotic single-site cholecystectomy at a single institution. Background Cholecystectomy is a common procedure performed to remove the gallbladder. Robotic single-site cholecystectomy (RSSC) is rapidly emerging as a safe and feasible alternative to conventional 4-port laparoscopic techniques. Patients who undergo RSSC procedures may also have a decreased need for postoperative analgesics and a lower postoperative pain score. Methods From September 2020 to August 2023, there were 33 cases of RSSC performed by a single surgeon at a single institution. We recorded demographic data including sex, age, and BMI as well as postoperative outcome data including wound dehiscence, postoperative infection, biliary leakage, wound herniation, blood loss, and conversion to open procedure. Results The patient group included 24 females (72.7%) and nine males (27.3%) with a median age of 32 (Range: 9-70) and a median BMI of 24.2 kg/m 2 (Range: 18.1-30.7). The majority of these patients were receiving cholecystectomies for benign conditions such as symptomatic cholelithiasis (n = 18, 54.5%), biliary dyskinesia (n = 13, 39.4%), acute cholecystitis (n = 1, 0.03%), and biliary colic (n = 1, 0.03%). The average estimated blood loss was 5.91 mL. Thirty-two patients (96.9%) were discharged home the same day of surgery. One patient was admitted overnight for observation due to severe biliary dyskinesia diagnosed preoperatively. The patient had no complications and was discharged the following day. One patient presented with acute abdominal wall cellulitis and omphalitis with no underlying abscess four weeks after the operation. They were treated with therapeutic antibiotics. No patients underwent conversion to an open procedure. There were no incidences of postoperative wound dehiscence or biliary leakages. One patient was admitted overnight for observation of biliary dyskinesia and another experienced abdominal wall cellulitis four weeks post-operation. Conclusions Although conventional multi-incision laparoscopic cholecystectomy remains the gold standard treatment for benign gallbladder disease, our study demonstrates the practicality and safety of Robotic Single-Site Cholecystectomy procedures., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Salim et al.)

Background: Though laparoscopic cholecystectomy has become a gold standard management technique for gallbladder diseases, an open approach can also be used for patients having complicated gallbladder disease. Post-cholecystectomy complications are well-documented in existing English scientific literature but are not well understood according to the grade of intervention required to treat those complications., Objective: To compare the postoperative complications of laparoscopic versus open cholecystectomy according to the modified Clavien-Dindo classification (MCDC) system., Materials and Methods:  A retrospective study was conducted at the Department of General Surgery, Unit - III, Lahore General Hospital, Lahore, comprising the data of patients operated between July 01, 2021, and December 31, 2021, after departmental approval # SU-III/73/LGH, dated April 1, 2022. Patients with the definitive diagnosis of acute cholecystitis, chronic cholecystitis, cholelithiasis, and cholecysto-duodenal fistula were included, while cases of choledocholithiasis and, gall bladder carcinoma were excluded from this study. Eighty patients met the inclusion criteria, with 40 patients in each group of open and laparoscopic cholecystectomy. Information for the data set of age, gender, history of surgical procedure, immediate and late outcome, length of surgery, and MCDC grade were collected. Low-grade complications were Grade I and Grade II, while Grades III to V were high-grade., Results: The mean age of included patients was 42.52 ± 8.76 and 40.025 ± 8.12 years, in the open and laparoscopic group, with 80% and 90% female preponderance, respectively. Grade I and Grade II complications occurred in both groups of patients, with Grade III only in patients who underwent open cholecystectomy. None of the patients from each group developed Grade IV or Grade V complications. Among 40 patients who underwent laparoscopic cholecystectomy, 35% of the patients developed low-grade complications, whereas 40% of the patients developed low-grade complications after open cholecystectomy, with respiratory complications being the most common. High-grade complications after open cholecystectomy were found among 2.5% of patients, whereas no patients developed high-grade complications following the laparoscopic approach., Conclusion: Patients who underwent laparoscopic cholecystectomy are less prone to develop complications than patients undergoing open cholecystectomy, hence requiring low-grade interventions of surgical and non-surgical types. MCDC is a valuable tool for assessing surgical complications and can help improve patient outcomes by providing a standardized method for reporting and comparing complication rates., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Khalid et al.)

Background: The elderly population is gradually increasing due to an increase in the quality of life and therefore the frequency of gallbladder stones in the population is also increasing. However, a considerable number of physicians tend to postpone or solve the problem with medical treatment instead of performing surgery in the elderly patients. In this study, we aim to compare the outcomes of laparoscopic cholecystectomy (LC) in the elderly and younger patients., Material and Methods: The medical records of 665 patients undergoing LC were evaluated retrospectively. The patients were divided into two groups: ≥60 years of age and <60 years of age. Ages, genders, comorbid diseases, indications of surgery, American Society of Anesthesiologists scores, whether it is converted to an open cholecystectomy or not, reasons for conversion if it is converted, total duration of surgery, initiation of oral nutrition, duration of discharge, and postoperative complications of the patients in both groups were recorded., Results: The American Society of Anesthesiologists scores were statistically significantly higher in ≥60 years age group (p<0.001). The rate of experiencing acute cholecystitis with a stone in the gallbladder was significantly higher in the 60 years group (p=0.025). Comorbidity was statistically significantly higher in the ≥60 years age group (p<0.001). Hospitalization period, the mean hour of initiation of oral nutrition were statistically significantly higher in the ≥60 years age group (p<0.001, p=0.001). Conversion to an open cholecystectomy and postoperative complication rates of the ≥60 years age group were statistically significantly higher (p=0.034, p<0.001)., Conclusion: We think that LC can be safely performed in the elderly people as well. However, it should be kept in mind that comorbidity may make the surgery and postoperative follow-up period complicated., Competing Interests: The authors have declared that no competing interests exist.