Clinical presentation and surgical management of cholelithiasis along with chemical analysis of gallstones

Abstract

Introduction: Cholelithiasis represents one of the most prevalent gastrointestinal disorders worldwide, affecting 10-15% of adults. Understanding its clinical presentation, management outcomes, and stone composition is crucial for optimal patient care. Methods: A prospective cross-sectional study was conducted on 100 patients with cholelithiasis who underwent cholecystectomy between 2021-2022. The study evaluated demographic profiles, clinical presentations, surgical outcomes, and chemical composition of gallstones. Results: The mean age of patients was 43.26 ± 11.26 years, with female predominance (68%). Most patients presented with symptomatic disease (70%), with pain and dyspepsia being the primary symptoms. Laparoscopic cholecystectomy was successfully performed in 79% cases, with a 16% conversion rate to open surgery. Main reasons for conversion included bleeding (4%), CBD injury (1.2%), and fibrosis of Calot's triangle (6%). Chemical analysis revealed mixed stones as the most prevalent (82%), followed by pigmented (12%) and cholesterol stones (6%). A notable age-related correlation was observed in stone composition, with cholesterol stones appearing exclusively in patients above 40 years. Conclusion: The study demonstrates that while laparoscopic cholecystectomy remains the gold standard treatment, proper patient selection is crucial. The predominance of mixed stones across all age groups and the age-related distribution of cholesterol stones suggest metabolic factors influencing stone composition.