Cholelithiasis: A Common With Dreaded Complications

Most patients want to avoid surgery in spite of being symptomatic and keep consulting Homeopath, Ayurveda, Unani, physician and family physician without relief from the cholelithiasis.

We know that there is no medicine which can treat cholelithiasis. The tall claims made by pharmaceutical companies are ridiculous. The medicines have to be taken over long periods with a lot of side effects and no perceptible relief.

Unfortunately, majority of the patients are misguided by the vested interest of the treating personnel, taking advantage of their fear for the surgical process.

Some of these patients land up in the emergency department with dreaded complications which can be life threatening.

It is absolutely clear that for symptomatic cholelithiasis, there is absolutely no choice except surgical removal of gall bladder.

The best time to perform surgery is within seventy-two hours of acute pain. There is a misconception among that the surgery should not be performed during pain of acute cholecystitis. If the patient has persistent pain, fever, leucocytosis and the ultrasound suggests empyema gall bladder, immediate surgical intervention is required irrespective of the duration of pain. Delayed treatment can lead to gangrene, perforation of gall bladder, septicaemia and mortality, particularly in elderly patients with comorbidity like diabetes mellitus.

The surgery for cholelithiasis should be performed as a planned surgery after proper workup as early as possible because delay can make surgery complicated with increased morbidity.

The commonest complications are:

1. Chronic cholecystitis
2. Slippage of stone to common bile duct leading to obstructive jaundice and will require two procedures to be performed, ERCP/ Laparoscopic lithotripsy followed by cholecystectomy
3. Empyema of gall bladder
4. Cholecystoduodenal / Cholecystocolic fistula
5. Gall stone ileus
6. Acute pancreatitis
7. Mirizzi syndrome
8. Carcinoma gall bladder

The problems faced by patients and surgeons in such situations are enormous. The risk of complications of surgery also increases.

The commonest complications of surgery in such situations are:

1. Bleeding
2. Common bile duct injury
3. Vascular injury
4. Avulsion of cystic duct and cystic vessels

Bailout procedures
Sometimes cholecystectomy is not possible and the surgeon has to perform cholecystostomy or sub-total cholecystectomy. Completion cholecystectomy is done at a later date with or without feeding jejunostomy.

Carry home message

1. Cholecystectomy is the only choice for cholelithiasis
   and should be performed as a planned surgery as
   early as possible to avoid complications.
2. Guide the patient appropriately.