Experience with Elective Cholecystectomy in King Khalid University Hospital

Mofti, Adnan B.; Al-Tameem, Mohsin; Al-Khudairy, Nail; Singh, Dhruva N. P.; Ahmad, Inam

doi:10.5144/0256-4947.1987.107

Cited by 9 publications

(7 citation statements)

References 7 publications

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“…Both factors may relate to chronic liver disease which is reported to be associated with increased gallstone formation [27,28]. We also thought the reported high prevalence of HBsAg in healthy blood donors from various parts of the Kingdom (6% to 10%) [29], and the remarkably high prevalence of HBsAg in the series of cholecystectomies reported from Riyadh (44% males and 11.4% females in the study) [4], may explain the common occurrence of gallstones at such a young age.A positive family history of gallstones was significantly higher in the patient population. A factor in the interpreting of this finding is that patients having suffered from the disease are more likely to be aware whether other members of the family have had a similar condition.…”

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confidence: 50%

“…It has been found that paradoxically weight reducing is held responsible for induction of gallstone formation [38][39][40][41] and the use of drugs such as chenodeoxycholic acid, uricodeoxycholic acid, terpenes or aspirin, may prevent this in patients on reducing diets [42][43][44][45]. Diabetes mellitus had been reported, though inconclusively, to be associated with gallstones [46] and was found in 22% of females and 19% of males in a series of cholecystectomies reported from Riyadh [4]. However, the findings in our study did not support this.…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study

Ahmed¹,

Elhassan

Mahmoud³

1992

Ann Saudi Med

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One hundred eighty-three young Saudi females (92 patients with gallstones, 91 controls) mean age and (SD), 30.2 (6.1) and 29.7 (6.4) years respectively were studied in detail for possible risk factors for gallstone formation. No statistically significant difference was found when the two groups were compared with regard to past history of jaundice, HBsAg carrier status, use of oral contraceptives, parity, diabetes mellitus, obesity (as Body Mass Index > 30), hypercholesterolemia and hypertriglyceridemia. However, it was noted that both groups were overweight; mean (SD) BMI of 27 (5.9) and 26.7 (6.8) for patients and controls respectively and both had high parity rates; mean and (SD) pregnancies of 4.7 (2.6) and 4.3 (2.9), respectively. Family history of gallstones in first degree relatives of patients was significant (.0027 < P < .01) more than in the controls (95% confidence interval of 3% to 23% ). This may suggest a genetic or an environmental factor that strikes the balance toward gallstone formation in the obese and fertile young female population. A larger nationwide, population-based study is surely justified and needed. AF Ahmed, OM El-Hassan, ME Mahmoud, Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study. 1992; 12(4): 395-399 It is our impression that gallstones are remarkably common in Saudis; no exact prevalence figures are available.Comparison of the prevalence of gallstones among different populations is notoriously difficult not only because of differences in availability of diagnostic facilities and attitudes toward treatment, but many patients who have gallstones remain symptom-free [1]. Thus, in Britain, only one in seven individuals with gallstones results in cholecystectomy [2], whereas in one population-based Italian study, 78% of subjects found to have gallstones were asymptomatic [3].According to our local statistics in Almadinah Almounawarah, approximately 350 to 400 cholecystectomies are performed each year in King Fahd Hospital and Ohud Hospital (Al-madinah Almounawarah's two main Ministry of Health (MOH) general referral hospitals, bed capacity 500 and 200, respectively); approximately 50% of elective laparotomies. A similar rate was reported from Riyadh, Saudi Arabia [4].Gallstone risk factors that could not be manipulated were female sex and advanced age [5][6][7][8][9]. We report a case control study of Saudi females, younger than 40 with and without gallstones; in relation to the following factors: parity, contraceptive pill, previous liver disease and HBsAg carrier state, family history of gallstones, obesity, diabetes mellitus, plasma lipids and total cholesterol and triglycerides. Subjects and Methods Definition of Cases and ControlsSaudi females younger than 40 who had a positive abdominal ultrasound scan for gallstones (cases) and sexand age-matched subjects with negative scan (controls) were studied. The presence or absence of symptoms or other diseases were not considered as an inclusion or exclusion criteria in selection of the cases and the...

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confidence: 50%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study

Ahmed¹,

Elhassan

Mahmoud³

1992

Ann Saudi Med

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“…In a recent study, 7.5% of pregnant women in this population were found to harbor silent gallstones, 17 in comparison to 3.5% in the West. The high incidence of biliary disease could be genetic, as suggested by Mofti et al, 19 as the genetic constitution of this society is well preserved by consanguinity. Early marriages with repeated pregnancies 16 and the well-documented deleterious effects of pregnancy on the biliary system are other possible causes.…”

Section: Discussionmentioning

confidence: 99%

Acute Abdomen in Pregnancy: Are Tocolytics and Early Surgical Intervention Justified?

et al. 1998

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Acute abdomen in pregnancy due to nonobstetric causes is accompanied by a high incidence of poor fetal outcome and maternal morbidity.1,2 Delay in surgical intervention, together with the operative maneuvers, are the main causes of the poor outcome. [3][4][5] Fear of the complication of a negative laparotomy in a pregnant female makes surgeons hesitant to interfere surgically, leading them to await clear-cut symptoms and signs of acute abdomen. 5,6 In pregnancy, these symptoms and signs are blunted by the anatomical displacement of the pregnant uterus 7 and the masking effect of the physiological symptoms of normal pregnancy, such as nausea, vomiting, mild abdominal pain and constipation. 8,9 Ironically, this delay, when prolonged, carries a high risk to the mother and fetus. 4 In acute abdomen in pregnancy, some have advocated aggressive early surgical intervention, 10-11 while others have adopted an initial trial of conservative treatment before resorting to surgery in case of failure. 4,12 Tocolytics are thought to calm the uterus from the insult of acute abdomen during conservative management or surgery, but this is controversial.13,14 The purpose of this article is to discuss the high incidence of acute abdomen, the effect of early surgical intervention on the maternal fetal health, and to evaluate the effect of tocolytics on pregnancy outcome. Subjects and MethodsAll cases of acute abdomen in pregnancy due to non-obstetric causes that were admitted to Asir Central Hospital (the main referral hospital in the region) from January 1991 to December 1993 were studied and analyzed. The parameters examined included the gestational age, acute abdomen symptoms and their duration before admission, signs, results of investigations, including ultrasound scanning, provisional diagnosis, the initial management plan (whether conservative or surgery and the criteria for either), tocolytic used, its nature, dose, side effects and its effects on the. fetal outcome, and whether abortion, preterm or term labor. Maternal morbidity was assessed by the duration of hospital stay, recurrent hospital admission, body temperature, nature of operation, postoperative complications and maternal health after delivery or abortion. The results of ultrasound scan and histopathology were compared to operative findings. The newborn charts were reviewed and any neonatal abnormality recorded.The chi-squared test, Fisher's exact test, and unpaired Student's t-test were used as tests of significance at the 5% level. For this purpose the software Statistical Package for Social Sciences (SPSS) was used. ResultsDuring the study period, there were 15,562 deliveries, of which 60 cases were provisionally diagnosed and admitted as having acute abdomen with pregnancy. The symptoms were severe abdominal pain, vomiting, constipation and signs of abdominal distension, rigidity, tenderness, abdominal mass, high temperature and rapid pulse. Table 1 summarizes the frequency of symptoms and signs.Depending on the severity of the above symptoms, patients were ei...

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“…In this study, the age and sex distribution is similar to what was published before. 5 Analysis of data showed no age difference between the patients with solitary stone and those with multiple gallstones. This age similarity makes one wonder why one patient would develop a solitary gallstone while another would develop multiple stones.…”

Section: Discussionmentioning

confidence: 99%

“…The incidence of solitary stones in this series is 12%, which is much lower than that reported by others. [1][2][3][4][5][6] The size of the stones was measured only in the solitary stone group. The range of the largest diameter of the solitary stone was 1.3 to 8.9 cm.…”

Section: Discussionmentioning

confidence: 99%

The Single Gallbladder Stone - Is it Innocent?

Mofti

Al-Momen

Suleiman

et al. 1994

Annals of Saudi Medicine

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At Security Forces Hospital, 692 consecutive patients underwent surgery for gallstone disease over a period of two years. Eighty of these patients had a solitary gallbladder stone. They are compared, by their presentation, operative findings, mortality and morbidity rates, with the remaining patients harboring multiple gallstones. The demographic data were similar in both groups; however, the frequency of developing mucocele, empyema, gallbladder perforation and postoperative complications were significantly higher in the group with solitary stones than those with multiple gallstones. Furthermore, the need for emergency surgical intervention and technically difficult surgeries were also more frequent in the single stone group. It appears that a solitary gallbladder stone is associated with increased risks more than multiple stones; hence, it may be justified to offer the patient with a solitary stone more attention and surgical priority. Ann Saudi Med 1994; 14(6):471-473.AB Mofti, A AI-Momen, SI Suleiman, SA Ismail, GC Jain, NM Hussein, HM Fayed, The Single Gallbladder Stone -Is it Innocent?. 1994; 14(6): 471-473 Cholecystectomy is the most frequently performed elective abdominal operation at our hospital. From our experience, we have an impression that solitary gallstone disease is associated with more complications and the surgery is often more difficult than in multiple gallstone disease. Hence, over a period of two years, we prospectively studied all patients with gallbladder and biliary duct stone disease admitted electively or urgently under our care. The aim of this study was to verify the impression that solitary gallbladder stone disease can be potentially more dangerous and risky than multiple stone disease. Despite our extensive literature search, only very few, and relatively old papers, addressed this problem before. 1-3 Material and MethodsThis was a prospective cohort study over a period of two years (October 1989 to September 1991). The clinical presentation, operative findings and outcome of all patients with gallstones admitted under our care were studied. The data were prospectively collected using a predesigned computer sheet. The clinical presentation, laboratory and radiological assessments, urgency of surgery, operative findings and difficulties, as well as postoperative complications were all documented and then analyzed.Biliary tract disorders due to strictures, malignant disease, retained stones or acalculus cholecystitis were excluded from the study. The patient population was divided into two groups, those confirmed operatively to have a single stone in the gallbladder (Group I), and those with multiple gallbladder stones (Group II). All group I patients had preoperative endoscopic retrograde cholangiopancreatography (ERCP) or operative cholangiogram to exclude the presence of any additional stones in the biliary system. All patients completed a follow-up period of at least one year postoperatively.The study sample size has a power of 95% in detecting a minimal difference of 10% a...

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Experience with Elective Cholecystectomy in King Khalid University Hospital

Cited by 9 publications

References 7 publications

Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study

Risk Factors for Gallstone Formation in Young Saudi Women: A Case Control Study

Acute Abdomen in Pregnancy: Are Tocolytics and Early Surgical Intervention Justified?

The Single Gallbladder Stone - Is it Innocent?

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