Results
Over a period of two years, two hundred and twenty patients with symptomatic gallstones were admitted for cholecystectomy. There were 193 females and 27 males with a male to female ratio of 1:7. The age ranged from 19 to 80 years with the mean age of 32.3 ± 5.3 years (Table 1). Majority of patients (92%) presented with upper abdominal pain of varying duration. Other symptoms are depicted in Table 2.
All 220 gallbladders were palpated and were opened per-operatively for any focal or diffuse thickening of the gallbladder wall, a raised mucosal plaque, polypoid growth or an infiltrating grey white mass. The specimens were then sent for histopathology. Two hundred and three of the specimens showed evidence chronic cholecystitis, 7 acute cholecystitis with mucocele, 3 acute cholecystitis with empyema and one incidental associated polyp. Six gallbladders (2.8%) showed evidence of adenocarcinoma of varying differentiation along with cholelithiasis, (Table 3).
There were six incidental carcinomas with no gross abnormalities in this series. Subsequent staging revealed three adenocarcinomas in stage T1b, two in stages T2 and one in T3 stage. Three patients with T1 tumors did not undergo any further procedure; three patients with advanced stages (T2 and T3) underwent revision surgery with resection of liver segments 4b and 5 (T2) and right hepatectomy (T3) along with lymphadenectomy. Port site rim of about 2 cms were also excised and sent for histopathology and was found to be free of tumor seedling in all three cases.