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Introduction While surgical indications for symptomatic cholelithiasis and biliary hypokinesia are clear, hyperkinetic biliary dyskinesia (HBD) is an underrecognized condition with poorly defined symptomology and management guidelines. HBD is typically defined as a gallbladder ejection fraction (EF) ≥ 80% on a hepatobiliary iminodiacetic acid (HIDA) scan. We aimed to identify the prevalence and radiographic reporting of HBD, physician referral patterns, and clinical outcomes following cholecystectomy. Methods  A retrospective cohort study of patients with HIDA scans completed over 21 years at our tertiary care hospital was performed. Demographics, symptomatology, referral patterns, and operative data were collected. HBD was defined as HIDA EF ≥80%. Patients with HBD who underwent cholecystectomy were analyzed. ANOVA and chi-square tests were used to compare variables among patients with or without symptom improvement using Statistical Product and Service Solutions (SPSS; IBM SPSS Statistics for Windows, Armonk, NY). Results Of 1,997 patients (73% female, mean age 51.7 years) who had HIDA scans with reported EF, 730 (36.6%) had an EF≥80%. Only 13.7% of HIDA scans with EF≥80% were reported as hyperkinetic, and the rest are normal. Cholecystectomy was performed in 57 (7.8%) patients with EF≥80%, most being elective (89.5%) and all minimally invasive. Primary care physicians (PCPs) referred most elective cases to surgery (61.4%). The median time from HIDA to cholecystectomy was 146 days. Chronic cholecystitis was common in pathology (82.5%), while 38.6% had cholelithiasis. Overall, 53 patients (93.0%) reported symptom improvement at a median follow-up of 17.0 days. Patients without improvement had a higher prevalence of chronic gastrointestinal conditions (p

Background Laparoscopic cholecystectomy represents a significant advancement in the treatment of gallbladder stones and cholecystitis, quickly becoming the preferred method over open surgery. It is one of the most frequently performed procedures by general surgeons. This technique offers benefits such as a shorter hospital stay, quicker recovery, improved cosmetic outcomes, and reduced morbidity. However, it is associated with a higher incidence of bile duct injuries compared to open surgery. A crucial part of planning for laparoscopic cholecystectomy involves assessing the potential difficulty of the procedure and the risk of needing to convert to open surgery. Methods This is a prospective observational study done at the Department of General Surgery, Krishna Rajendra Hospital, Mysore over a period of 1 year from September 2022 to September 2023 with a sample size of 100 patients with symptomatic gall stone disease, with informed consent. Pre-operative predictors were recorded, intra-operative predictors were recorded. Difficulty of the surgery was documented. Data was entered and analysed. Results 100 subjects were studied, 78 females and 22 males. 80 of them had <6 preoperative score and 20 of them had 6-10 score. 30 subjects had <2 intraoperative score, 47 had 2-4 score, 19% had 5-7 score and 4% had >7 score. 61 surgeries were easy, 32 were difficult and 7 extremely difficult. There was 1 bile duct injury and 7 conversions to open. Fischer’s exact test used for the two scores found a significant association between the score and the difficulty of laparoscopic cholecystectomy with 71.8% sensitivity and 70.5% specificity for preoperative and 79.5% sensitivity and 73.8% specificity for intraoperative scores (AUC 0.762 and 8.24 respectively p<0.05). History of acute cholecystitis, >4mm wall thickness and pericholecystic collection had significance in predicting difficult laparoscopic cholecystectomy. Conclusions Preoperative and intraoperative scores were both significant predictors for difficult surgery. History of acute cholecystitis, >4mm wall thickness and pericholecystic collection were preoperative factors that independently predicted difficult surgery. Application of these scores and noting the significant preoperative factors will aid appropriate planning and management of laparoscopic cholecystectomies. [ABSTRACT FROM AUTHOR]

Background Asymptomatic cholelithiasis is a frequent condition which affects up to 10% of the adult population. Acute cholecystitis develops in up to 2% of patients affected by asymptomatic cholelithiasis. Gallbladder perforation (GBP) develops in up to 2 to 11% of acute cholecystitis cases. Based on Niemeier classification GBP is classified into 3 types, type II being most common presentation. Methods Retrospective descriptive case series of all patient presenting with signs and symptoms of cholecystitis and was diagnosed with GBP radiologically was included in the study from the year February 2022 to January 2024 in the Krishna Rajendra hospital of Mysore medical college and research institute Mysore. Common clinical presentation in these patients were abdominal pain mainly in upper quadrant, nausea, jaundice, tenderness over the right upper quadrant, fever and peritonitis. Results Total 43 patients were studied; Out of which 51.2% were males and 48.8% were females. 76.7% had cholelithiasis. Gall bladder perforation was classified into 3 types based on NIEMEIER classification, type 2 being the most common (88.4%). Most people underwent conservative management (70%) followed by pigtail & percutaneous cholecystostomy .2 patient succumbed to death out of 43 patients. Conclusion Gallbladder perforation even though rare but should be considered in case of cholecystitis and further it should be classified based on Niemeier's classification and should be treated accordingly. Failure in diagnosis and management will lead to mortality and morbidity of the patient. [ABSTRACT FROM AUTHOR]

Introduction Gall stones are currently classified based mainly on their composition. Though some studies have suggested differences in patients with multiple and solitary gallstones, there is sparse data regarding this, leaving a lacuna for research work which could help expand our understanding of the disease. Aim & Objectives Evaluation of difference in presentation, surgical implications and complications between patients of solitary and multiple gall stone disease. Methods 100 patients admitted with and undergoing surgery for cholelithiasis and its complications at Muzaffarnagar Medical College & Hospital, Muzaffarnagar (UP, India) were divided into two groups- those with single gall stones, and those with multiple gall stones. Results In our study, 63 cases had multiple gallstones, while 37 had a single gallstone. No significant difference was found between the two groups with respect to the studied symptoms. However, a significantly higher percentage of patients with multiple stones suffered from acute cholecystitis (p value 0.014), and choledocholithiasis (p value 0.015), as compared to those with single stones. Mucocele was found to be significantly more common in single stone patients (p-value = 0.001). The comparison of the duration of cholecystectomy, prevalence of dense adhesions, and rate of lap to open conversions revealed no statistically significant difference between the two groups. Conclusion While differential rates of some complications were observed between patients with single and multiple gall stones, the symptom profile was similar and no significant difference between the two groups regarding operative difficulties could be illustrated. [ABSTRACT FROM AUTHOR]

Reports of pancreatic pseudocyst drainage during metabolic bariatric surgery are extremely rare. Our patient is a 38-year-old female suffering from obesity grade IV and presents a persistent symptomatic pancreatic pseudocyst 8 months after an episode of acute biliary pancreatitis. After an extensive evaluation and considering other treatment options, our multidisciplinary team and the patient decided to perform a one-stage procedure consisting of laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass. After bringing the patient to the operating room, the surgeon performed an anterior gastrostomy to access the stomach's posterior wall, followed by a 6-cm cystogastrostomy on both the stomach's posterior wall and the cyst. Next, a cholecystectomy which involved dissecting the triangle of Calot was performed. Then, an 18-cm gastric pouch using a 36-Fr calibration tube was created. The cystogastrostomy was left in the remaining stomach. Finally, gastrojejunal anastomosis is done. The patient's postoperative course proceeded smoothly, leading to her home discharge on the third postoperative day. At the 1-year follow-up, the patient had lost 56 kg and was symptom-free; a computer tomography scan showed that the pancreatic pseudocyst had resolved. This case shows a video of a successful laparoscopic cystogastrostomy, cholecystectomy, and one-anastomosis gastric bypass (OAGB) used to treat persistent abdominal pain and obesity grade IV. We also conduct a bibliographic review. [ABSTRACT FROM AUTHOR]

Background: Cholelithiasis is one of the more common complications following bariatric surgery. This may be related to the rapid weight loss during this period, although the exact mechanism of gallstone formation after bariatric surgery has not been fully elucidated. Methods: The present literature review focuses on risk factors, prevention options and the impact of the gut microbiota on the development of gallbladder stones after bariatric surgery. Results: A potential risk factor for the development of cholelithiasis after bariatric surgery may be changes in the composition of the intestinal microbiota and bile acids. One of the bile acids—ursodeoxycholic acid—is considered to reduce the concentration of mucin proteins and thus contribute to reducing the formation of cholesterol crystals in patients with cholelithiasis. Additionally, it reduces the risk of both asymptomatic and symptomatic gallstones after bariatric surgery. Patients who developed gallstones after bariatric surgery had a higher abundance of Ruminococcus gnavus and those who did not develop cholelithiasis had a higher abundance of Lactobacillaceae and Enterobacteriaceae. Conclusion: The exact mechanism of gallstone formation after bariatric surgery has not yet been clarified. Research suggests that the intestinal microbiota and bile acids may have an important role in this. [ABSTRACT FROM AUTHOR]

Introduction: Postoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan. Methods: A cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher's exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting. Results: 190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21–40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9–11.2, p < 0.001), and use of sodium thiopental (OR 4.1, 95%CI 1.9–9.1, p < 0.001) were independent risk factors for PONV. The use of antiemetics (OR 0.1, 95%CI 0.0-0.4, p = 0.002), propofol (OR 0.2, 95%CI 0.1–0.5, p < 0.001), adjuvant analgesic paracetamol (OR 0.4, 95%CI 0.2–0.8, p = 0.026), and adequate hydration with IV fluids (OR 0.9, 95%CI 0.9-1.0, p = 0.042) were preventive factors for PONV. Conclusion: The rate of PONV after laparoscopic cholecystectomy was high. History of motion sickness and use of sodium thiopental for induction were independent risk factors of PONV. The use of multimodal prophylactic antiemetics was robust and superior to monotherapy in preventing PONV. This finding re-emphasizes the need for risk stratification and appropriate use of antiemetics and anesthetic agents to prevent PONV. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusion Observational studies have shown that cholelithiasis and cholecystectomy are associated with the risk of breast cancer (BC) and gynecological cancers, but whether these relationships are causal has not been established and remains controversial.Our study began with a meta‐analysis that synthesized data from prior observational studies to examine the association between cholelithiasis, cholecystectomy, and the risk of BC and gynecological cancers. Subsequently, a two‐sample Mendelian randomization (MR) analysis was conducted utilizing genetic variant data to investigate the potential causal relationship between cholelithiasis, cholecystectomy, and the aforementioned cancers.The results of the meta‐analysis demonstrated a significant association between cholecystectomy and the risk of BC (risk ratio [RR] = 1.04, 95% confidence interval [CI]: 1.01–1.06, p = 0.002) and endometrial cancer (EC) (RR = 1.26, 95% CI: 1.02–1.56, p = 0.031). Conversely, no significant association was observed between cholelithiasis and the risk of BC, EC, and ovarian cancer. The MR analysis revealed no discernible causal connection between cholelithiasis and overall BC (p = 0.053), as well as BC subtypes (including estrogen receptor‐positive/negative). Similarly, there was no causal effect of cholecystectomy on BC risk (p = 0.399) and its subtypes. Furthermore, no causal associations were identified between cholelithiasis, cholecystectomy, and the risk of gynecological cancers (ovarian, endometrial, and cervical cancer [CC]) (all p > 0.05).This study does not support a causal link between cholelithiasis and cholecystectomy and an increased risk of female cancers such as breast, endometrial, ovarian, and CC. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic cholecystectomy is gold standard procedure for routine gall bladder removal nowadays. It has become the preferred surgery of choice for patients with symptomatic cholelithiasis in the last two decades due to its shorter duration of hospital stay, reduced post operative morbidity and better cosmesis Materials and Methods: A retrospective observational study was done in 75 patients who underwent laparoscopic cholecystectomy in Vydehi Institute of Medical Sciences & Research Centre Bangalore. Patients were divided into 2 groups based on gender and comparison in terms of age of presentation, intra operative complications, duration of surgery, post operative complications, POD 1 pain was done. The duration of hospital stay was also compared Results: The duration of surgery was significantly greater in males (50.65 +/- 8.73) than female group (37.80 +/- 8.78, p < 0.001). Normal anatomy was significantly in greater proportion in females (63.6% ) than males (25.0%, p < 0.001). Intra operative complications such as bile spillage (12.9%), bleeding (6.5%) and bile leak (3.2% ) was significantly more in male than females (p < 0.42). The hospital stay and post op day 1 pain was seen more in males than females. There was no difference between the genders with respect to age (0.118) and post operative complications (p = 0.222) Conclusion: This study suggests that male gender can be a predictor of difficult laparoscopic cholecystectomy. [ABSTRACT FROM AUTHOR]

Background: Cholelithiasis is one of the most common surgical problems throughout the world. Earlier, the prevailing treatment of symptomatic Cholelithiasis was an open cholecystectomy which is almost replaced by laparoscopic cholecystectomy. Although occasionaly switch to open cholecystectomy may require during the procedure which is known as conversion in laparoscopic cholecystectomy. Many factors contribute to the conversion which is not a sign of surgeon's failure rather is a sign of surgeon's good surgical judgment Our objectives are to find out the factors which are associated with conversion and thus reduce conversion rate, preoperative preparation and counseling the patient for conversion in laparoscopic cholecystectomy. Methods: This was a hospital based retrospective study, carried out in department of hepatobiliary & pancreatic surgery department, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from January 2008 to December 2009. A total no of SO cases were included in our study which were converted to open cholecystectomy. Cases were collected from the hospital medical records which were retrieved and analyzed. Result: A total no of768 laparoscopic cholecystectomies were attempted during the study period. Out of which SO cases were converted to open cholecystectomy. Thus the conversion rate was 6.5%. Among these the reasons for conversion in both genders were dense adhesion in 22 (2.86%), aberrant anatomy in 10 (1.3%), empyema gall bladder in 4 (0.52%), per operative findings of choledocholithiasis in 3 (0.39%), suspicion of common bile duct injury in 3 (0.39%), others causes of conversion included uncontrolled bleeding 3 (0.39%), thick fibrosed gall bladder 2 (0.26%), accidental bowel injury 2 (0.26%), Type-I choledochal cyst 1 (0.13%) cases. Conclusion: various factors are related to conversion in laparoscopic cholecystectomy. But due to improvement of learning curve, good quality operative equipment, now a day's laparoscopic cholecystectomy is safe method of treatment for gall stone diseases with very low conversion rate. [ABSTRACT FROM AUTHOR]

CHOLELITHIASIS, A WIDESPREAD GLOBAL CONCERN, OFTEN NECESSITATES SURGERY. SYMPTOMS VARY, AND GALLSTONES MAY NOT SOLELY TRIGGER SYMPTOMS, REQUIRING PRECISE DIAGNOSIS TO PREVENT UNNECESSARY CHOLECYSTECTOMIES. EMPLOYING UPPER GI ENDOSCOPY ASSISTS IN ACCURATE DIAGNOSIS, AVERTING SYMPTOM MISINTERPRETATION. THIS STUDY DELVES INTO THE CORRELATION BETWEEN CHOLELITHIASIS, GERD, AND THEIR SYMPTOMS, ADVOCATING PREOPERATIVE UPPER GI ENDOSCOPY TO DETECT ASSOCIATED UPPER GI DISORDERS AND MINIMIZE UNNECESSARY SURGERIES. THE AIM IS TO PROBE THE RELATIONSHIP BETWEEN GERD AND CHOLELITHIASIS. OBJECTIVES INCLUDE EVALUATING GERD SYMPTOMS USING THE "GERDQ" SCORE, SCRUTINIZING UPPER GI ENDOSCOPY FINDINGS, AND CORRELATING GERDQ SCORES WITH ENDOSCOPY RESULTS IN 120 PATIENTS FROM GMC, GGH ANANTAPURAMU. INCLUSION CRITERIA ENCOMPASS PATIENTS AGED 18 OR OLDER WITH CONFIRMED GALLBLADDER STONES VIA ABDOMINAL ULTRASOUND, CONSENTING TO PARTICIPATE IN THE STUDY. EXCLUSIONS COMPRISE COMPLEX GALLSTONE CONDITIONS. STATISTICAL ANALYSIS PERFORMED USING SPSS 16.0 SOFTWARE. AMONG 120 PATIENTS WITH DYSPEPTIC SYMPTOMS AND CONFIRMED CHOLELITHIASIS, THOSE AGED 30-60 YEARS (65.8%) WERE PREDOMINANT, WITH FEMALES CONSTITUTING 64.2%. NAUSEA, REGURGITATION, HEARTBURN, AND ABDOMINAL PAIN WERE PREVALENT SYMPTOMS, WITH GASTRITIS/GASTRIC ULCERS (45.8%) AS THE MOST FREQUENT ENDOSCOPIC FINDINGS. THE GERDQ SCORE EFFICIENTLY SCREENS PATIENTS AND HAS POSITIVE CORRELATION WITH GERD. TYPICAL ENDOSCOPIC FINDINGS INCLUDE GASTRITIS/GASTRIC ULCERS, HIATUS HERNIA, ESOPHAGITIS, AND DUODENITIS. INITIAL MEDICAL MANAGEMENT IS ADVISED FOR PATIENTS WITH DYSPEPSIA, GALLSTONES, HIGH GERDQ SCORES, AND SIGNIFICANT ENDOSCOPIC FINDINGS. ROUTINE PREOPERATIVE UPPER GI ENDOSCOPY IS RECOMMENDED FOR ALL DYSPEPTIC PATIENTS WITH GALLSTONE DISEASE TO AVOID UNNECESSARY CHOLECYSTECTOMY. [ABSTRACT FROM AUTHOR]

Christopher Thom, Justin Yaworsky, Kevin Livingstone, David Han, Jakob Ottenhoff Department of Emergency Medicine, University of Virginia Health System, Charlottesville, Virginia, USACorrespondence: Christopher Thom, University of Virginia Health System, 1215 Lee Street, Charlottesville, Virginia, 22903, USA, Email ct9k@hscmail.mcc.virginia.eduBackground: Biliary ultrasound is often utilized in the evaluation of abdominal pain in the Emergency Department (ED). Common bile duct (CBD) identification is traditionally a standard component of the biliary ultrasound examination but can be challenging to perform for the novice sonographer. Previous work has demonstrated that CBD dilatation is rare in cases of cholecystitis with normal liver function tests (LFTs). We sought to assess the frequency of CBD dilatation in the subset of ED patients undergoing hepatobiliary ultrasound who have normal LFTs and an absence of gallstones or biliary sludge on ultrasound. We also performed an assessment of changes in CBD diameter by age and cholecystectomy status.Methods: This was a retrospective chart review at a single academic ED. Patients were enrolled in the study if they underwent a radiology performed (RP) hepatobiliary ultrasound within the 2 year study period. Records were reviewed for the presence of gallstones or sludge, CBD diameter, age, clinical indication for the ultrasound, and LFTs. Descriptive analyses were performed, and interobserver agreement among data abstractors was assessed by K analysis for the presence of CBD dilatation. The Mann–Whitney test was utilized to assess statistical significance in the comparison of differences between CBD diameters amongst age groups.Results: Of 1929 RP hepatobiliary ultrasounds performed in the study period, 312 were excluded and 1617 met inclusion criteria. Amongst these, there were 506 patients who had normal LFTs and an ultrasound with no stones or sludge. Ten patients within this group had a dilated CBD > 7 mm (1.98%, 95% CI of 1.08% to 3.6%). We also noted a statistically significant increase in CBD size in the older age cohort and in those individuals with a history of cholecystectomy.Conclusion: CBD dilation in ED patients who present with normal LFTs and an absence of gallstones and biliary sludge is rare. Physicians should be reassured that the routine identification of the CBD on ultrasound in this setting is of low yield and need not be pursued.Plain Language Summary: The common bile duct is often taught as part of the biliary point-of-care ultrasound examination. However, it is more challenging to identify than the gallbladder and thus may limit adoption of POCUS by ED physicians. Our study adds to the body of work demonstrating that omitting the common bile duct from an ultrasound evaluation is likely reasonable when both the gallbladder and liver function tests are normal. Our study also adds to the literature regarding the increase in common bile duct size with age and with post-cholecystectomy status.Keywords: biliary, common bile duct, ultrasound, gallstones, cholelithiasis, point-of-care ultrasound

Abstract Introduction Postoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan. Methods A cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher’s exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting. Results 190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21–40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9–11.2, p

Nigeria has the highest population of people with sickle cell disease globally. As these patients live longer chronic complications are bound to be encountered more frequently. This case report presents two adolescents with gallbladder stones, to highlight the increasing importance of the condition as a cause of acute and recurrent abdominal pain in Nigerian sicklers. First patient is a 14year old male sickler with recurrent abdominal pain, and typical changes in the stool, over a period of six months. Abdominal ultrasonography revealed gallbladder stones as the most likely cause of the pain. The second patient is a 17-year-old male who presented with a day history of abdominal pain. Ultrasonography also revealed gallbladder stone as the most likely cause of the pain. It is concluded that gallbladder stone is becoming an increasing important cause of abdominal pain in Nigerian sicklers. Abdominal ultrasonography with a deliberate search for gallbladder stones should be routine in sicklers presenting with abdominal pain.

Cholelithiasis is a common biliary tract disease. However, the exact mechanism underlying gallstone formation remains unclear. Mucin plays a vital role in the nuclear formation and growth of cholesterol and pigment stones. Excessive mucin secretion can result in cholestasis and decreased gallbladder activity, further facilitating stone formation and growth. Moreover, gallstones may result in inflammation and the secretion of inflammatory factors, which can further increase mucin expression and secretion to promote the growth of gallstones. This review systematically summarises and analyses the role of mucins in gallstone occurrence and development and its related mechanisms to explore new ideas for interventions in stone formation or recurrence. [ABSTRACT FROM AUTHOR]

Objective: The metabolic parameters associated with gallstones are the subject of numerous studies. RBP4, an adipokine, has been linked to various metabolic diseases; however, no study in the literature establishes its relationship with gallstone disease. Therefore, our study aimed to evaluate the biochemical parameters associated with gallstone disease, primarily serum RBP4. Material and Method: Between 2015 and 2016, abdominal ultrasound, serum biochemical tests, lipid profiles, uric acid, insulin, and fasting glucose values were available for 80 patients who presented to our hospital's gastroenterology clinic, were included in the study. RBP4 levels were analyzed in the serum samples obtained from the patients. Results: Out of the 80 participants in the study, 42 had gallstones, while 38 did not. Among the biochemical parameters, no significant difference was found between the groups in terms of total cholesterol values (p= 0.483), LDL values (p=0.224), and TG values (p=0.764). A significant difference was observed between the two groups regarding HDL values(p=0.017). No significant difference was found between the two groups in terms of serum uric acid (p=0.411), fasting glucose (p=0.214), fasting insulin, HOMA-IR score (p=0.157), and vitamin D levels (p=0.340). The mean±SD values of the studied serum RBP-4 levels in the participants were determined as 40.24±7.12 in the control group and 39.75±8.55 in the patient group. No statistically significant difference was found between the two groups (p=0.776). In correlation analyses, a significant positive correlation was found between RBP4 and vitamin D levels (r: 0.277, p= 0.013), total cholesterol (r: 0.268, p=0.016), triglycerides (r: 0.387, p<0.001), GGT (r: 0.294, p=0.008), AST (r: 0.299, p=0.007), and uric acid (r: 0.255, p=0.022). Conclusion: In conclusion, our study did not find a statistically significant relationship between gallstones and RBP4, vitamin D, LDL, TG, total cholesterol, uric acid, and HOMA-IR. However, our study found a positive correlation between vitamin D levels and RBP4. This has guided future research. [ABSTRACT FROM AUTHOR]

Objective This article aims to investigate the association between hypertension and the risk of GSD by conducting a national multicenter study, a systematic review, and a meta-analysis. Methods The study was conducted in three stages. In the first stage, subjects were recruited for health examination in four hospitals in Chengdu, Tianjin, Beijing, and Chongqing, China, from 2015 to 2020, and the multivariate logistic regression analysis was used to investigate the association between hypertension and the risk of GSD in each center. In the second stage, Embase, PubMed, Wanfang Data, VIP, and CNKI databases were searched for related studies published up to May 2021, and a meta-analysis was conducted to further verify such association. In the third stage, the random effects model was used for pooled analysis of the results of the multicenter cross-sectional study and the findings of previous literature. Results A total of 633 948 participants were enrolled in the cross-sectional study, and the prevalence rate of GSD was 7.844%. The multivariate logistic regression analysis showed that hypertension was positively associated with the risk of GSD (P<0.05). Subgroup analysis showed that there was no significant difference in the association between hypertension and GSD between individuals with different sexes, ages, and subtypes of GSD. A total of 80 articles were included in the systematic review and the meta-analysis, and the results showed that the risk of GSD was increased by 1.022 times for every 10 mmHg increase in diastolic pressure and 1.014 times for every 10 mmHg increase in systolic pressure. Conclusion Hypertension significantly increases the risk of GSD, and the findings of this study will provide a basis for the etiology of GSD and the identification of high-risk groups. [ABSTRACT FROM AUTHOR]

Objective: To determine the ability of "Galbladder Operating Score (G10)" to predict difficulty of surgery and timely conversion of laparoscopic to open cholecystectomy. Study Design: Cross sectional study. Place and Duration of Study: General Surgery Unit of Combined Military Hospital, Rawalpindi Pakistan, from Nov 2021 to Nov 2022. Methodology: One hundred and eleven cases scheduled to undergo laparoscopic cholecystectomy were recruited. After an informed consent age, gender, Body Mass Index, G10 score and category of severity ranging from mild to extreme was documented. Operative time was documented to define difficult cholecystectomy alongside conversion of laparoscopic to open cholecystectomy. Results: A total of 111[53(47.70%) male and 58(52.30% female)] cases who were scheduled to undergo laparoscopic cholecystectomy were included with mean age of 43.36±5.33 years. Median G10 score of patients was 3.00 (range: 1.00-8.00). Overal frequency of conversion from laparoscopic to open cholecystectomy was 9(8.10%). G10 between the study participants who experienced conversion of laparoscopic to open cholecystectomy as compared to those who had their laparoscopic cholecystectomy completed was statisticaly significant (p=0.003). Conclusion: Galbladder Operating Score (G10) is helpful in predicting the difficulty cholecystectomy and conversion of laparoscopic to open cholecystectomy. [ABSTRACT FROM AUTHOR]

Cholelithiasis is a common disease but pose significant global health and financial burdens. Mechanisms of the disease are associated with insulin resistance (IR), obesity, metabolic syndrome, and type 2 diabetes. Insulin resistance is commonly observed in cholelithiasis patients. More recently, the triglyceride-glucose (TyG) index has been proposed as an alternative marker of insulin resistance. In our study we aimed to understand whether the TyG index is correlated with HOMA-IR in cholelithiasis patients. And also we aimed the predict a cutoff value for determining insulin resistance in cholelithiasis patients. A total of 184 cholelithiasis patients were matched in terms of age, gender, and BMI. They were divided into two groups based on their Homa IR levels (IR and Non-IR group). This study was a retrospective, observational study and clinical data was obtained from electronic medical records. Cutoff value for Tyg index was established through ROC Analysis. Binary Logistic Regression was used to identify factors affecting insulin resistance. A significant cutoff value was found for the TyG index in determining the presence of insulin resistance. Having a TyG index of ≥8.71 indicates the presence of insulin resistance. The sensitivity was 68.48%, the specificity was 58.70%. Binary Logistic Regression analyses showed that an increase in Tyg Index, waist circumference and waist-to-height ratio values increases the risk of insulin resistance by 2.705 (p = 0.001), 1.032 (p = 0.029), and 334.057 (p = 0.012) times respectively. Our study indicated that TyG index is positively correlated with HOMA-IR. TyG index was found as a risk factor for insulin resistance. [ABSTRACT FROM AUTHOR]

Cholelithiasis is a common digestive disease that drives a myriad of adverse complications. The correlation between sarcopenia and various digestive disorders has been extensively researched, whereas its association with cholelithiasis remains unreported. We aimed to investigate the association through prospective and Mendelian randomization (MR) analyses and establish a quantitative score reflecting the impact of sarcopenia‐related markers on cholelithiasis. The prospective study involved 448 627 participants from the UK Biobank. Cox proportional hazard models were employed to investigate the correlation between sarcopenia‐related markers and cholelithiasis. To quantitatively assess cholelithiasis risk, the SARCHO score was derived from a multivariable Cox model. Bidirectional two‐sample MR analysis was conducted to validate the causal association. A total of 16 738 individuals developed cholelithiasis during a median follow‐up of 12 years. Hazard ratios (HRs) of cholelithiasis decreased stepwise over skeletal muscle index tertiles (highest tertile: reference; middle tertile: 1.23, p <.001; lowest tertile: 1.33, p <.001). The tertiles of grip strength showed a similar pattern. Individuals with slow walking pace had a higher risk of cholelithiasis compared to those with normal walking pace (HR 1.23; p <.001). Our SARCHO score better quantifies the risk of cholelithiasis. MR analysis showed a causal relationship between muscle mass and cholelithiasis (OR 0.81; p <.001). No causal effect of cholelithiasis on lean mass was observed. Prospective and MR analyses have consistently demonstrated an increased risk of cholelithiasis in individuals with decreased muscle mass. Additionally, SARCHO score further quantified the cholelithiasis occurrence risk. These findings provide compelling evidence for muscle strengthening in preventing cholelithiasis. [ABSTRACT FROM AUTHOR]