Rapid Formation of Cholesterol Crystals in Gallbladder Bile Is Associated With Stone Recurrence After Laparoscopic Cholecystotomy

Abstract

it avoids injury to the common biliary duct and leaves the Laparoscopic cholecystotomy (LCT) with subsequent gallbladder in situ after the removal of stones. extraction of gallstones and primary closure of the gall-The technique can be used in patients with a functioning bladder has been introduced as an alternative therapy gallbladder irrespective of the composition or number of for patients with cholecystolithiasis and preserved gallstones. However, stone recurrence has to be considered a bladder function. However, stone recurrence has to be major drawback. Postdissolution trials have shown that considered as a major drawback that might be related when gallbladder stones have been completely dissolved and to lithogenic factors of gallbladder bile or the composibile-acid treatment is withdrawn, stones recur in 28% to 61% tion of gallbladder stones. Therefore, these were studied of patients after 2 to 12 years. [3][4][5] Comparable results were in relation to stone recurrence within an observation obtained after successful treatment of gallbladder stones by period of 1 to 5 years (median, 3.6 years) in 50 patients extracorporeal shock wave lithotripsy (ESWL). 6-8 Therefore, after LCT. The concentrations of total and individual the study of factors associated with recurrent stones is of bile acids, phospholipids, cholesterol, total lipids, mucin, crucial importance. The impact of impaired motility of the protein, and the cholesterol saturation indices in gallgallbladder on gallstone recurrence after ESWL has been bladder bile were not significantly different between 10 demonstrated recently. 9 However, nothing is known whether patients with and 40 patients without stone recurrence.lithogenic factors of gallbladder bile or the composition of However, the crystal observation time was significantly stones might affect recurrence rates after successful gallstone (P õ .02) shorter (range, 1-2 days; median, 1.5) in the treatment that leaves the gallbladder in situ. The introducbile of patients with stone recurrence compared to those tion of LCT as an alternative treatment of gallstones allows without (range, 1-21 days, median 3.5). Moreover, all 10 for the first time a prospective study of these relationships. stone recurrences were observed in the 28 patients withThis prompted us to analyze gallbladder bile and stones cola crystal observation time in the bile of less than or equal lected at the time of LCT and to compare these data with the to 2 days (approximate annual risk: 12%-15%), and no rate of stone recurrence as determined by repeated ultrasorecurrences were observed in the 22 patients with a crysnography. tal observation time greater than 2 days (P õ .0001) or in patients with pigment stones. The rapid formation of PATIENTS AND METHODS cholesterol monohydrate crystals in bile seems to be the major risk factor for recurrent stones after LCT. These Patients and Collection of Bile. Fifty patients, 38 women (mean are most likely cholesterol stones and, therefore, are age range, 47.8 { 10.5 years) and 12 men (mean...

Onion ring sign on spectral domain optical coherence tomography in diabetic macular edema: Its evolution and outcomes

“…1 CC are associated with a number of systemic diseases such as atherosclerosis, cholecystolithiasis and chronic apical periodontitis. [2][3][4] Cholesterol crystallization has been associated with extensive chronic vascular exudation in several ophthalmologic conditions, recently including AMD. [5][6][7] Hard exudate (HE) in the eye is a combination of lipid and proteinaceous material such as fibrinogen and albumin occurring as a result of vascular leakage due to impaired blood-retinal barrier.…”

“…1 CC are associated with a number of systemic diseases such as atherosclerosis, cholecystolithiasis and chronic apical periodontitis. 2–4 Cholesterol crystallization has been associated with extensive chronic vascular exudation in several ophthalmologic conditions, recently including AMD. 5–7…”