Cholecystectomy is becoming an increasingly common operation in Hyderabad and adjoining areas

Transcription

1 Original Article Cholecystectomy is becoming an increasingly common operation in Hyderabad and adjoining areas Naseem Aslam Channa, Ali Mohammad Soomro, Allah Bux Ghangro From Institute of Biochemistry and Faculty of Pharmacy, University of Sindh, Jamshoro, 71000, Pakistan, Correspondence: Dr. Naseem Aslam Channa, Institute of Biochemistry University of Sindh, Jamshoro, Pakistan. address: Received: April 4, 2007 Accepted: May 2, 2007 ABSTRACT Objective: To see the frequency of cholecystectomy in Hyderabad and adjoining areas during the year 2002 to Methods: The records of patients admitted in Liaquat University Hospital Jamshoro, Wali Bhai Rajputana Hospital, Memon Charitable Hospital, Naseem Medical Center, and Isra University from January 2002 to December 2005 were reviewed. Results: The overall frequency of cholecystectomy was found to be 11.14% (95% CI, ). The frequency of cholecystectomy in males was 3.8% and in females 22.4%, constituting male to female ratio 1:6. The age range for male gallstone patients was 10 to 78 years and for females 11 to 80. The peak age group for the presentation of gallstones in males and females was years. Highest male to female ratio was observed in the age of years age group. Conclusion: The frequency of cholecystectomy has increased from 9.03% to 11.14% (95% CI, ) in Hyderabad and adjoining areas during 2002 to (Rawal Med J 2007;32: ). KEY WORDS: Frequency of cholecystectomy, Pakistan, females, pregnancy. 1

2 INRODUCTION Gallstone disease is a widespread disorder all over the world and cholecystectomy is one of the most common elective abdominal operations. 1 Most gallstones never generate symptoms, but they can cause pain and biliary complications. 2 Only in a minority of subjects with symptomatic gallstones is treatment required. 3 Gallstones are more common in adults than in children or elderly persons; in females than in males and the causes for these age- and sex-related variations are now well known. 4 Prevalence of cholelithiasis has been well reported 5 and frequency of cholecystectomy had been addressed by some investigators. 6,7 The frequency of cholecystectomy in a previous study was found to be and in Hyderabad and adjoining areas. The present study was undertaken to see the present frequency of cholecystectomy in our area. MATERIALS AND METHODS This was a hospital based study on patients admitted in major tertiary care hospitals of Hyderabad and adjoining areas consisting of Liaquat University Hospital Jamshoro, Isra University Hospital, Naseem Medical Center, Wali Bhai Rajputana Hospital and Memon Charitable Hospital, all in Hyderabad. The records of all patients undergoing cholecystectomy in these hospitals from January 2002 to December 2005 were reviewed. Gallstone patients who were admitted for cholecystectomy and left the hospital without cholecystectomy were excluded. Cholecystectomy frequency with 95% confidence intervals was computed by standard jackknife s method. The gallstone patients were further stratified by gender, age groups, and hospitals. Male to female ratio were also calculated. 2

3 RESULTS A total of surgeries were performed with 3032 cholecystectomies in these hospitals during the study period (table 1). All gallstone patients were the residents of the Hyderabad and adjoining areas. Overall frequency of cholecystectomy was 11.14% (95% CI, ). The highest surgical incidence of cholelithiasis was reported for Memon Charitable Hospital (15.28%) followed by Wali Bhai Rajputana Hospital (9.49%). Isra University Hospital dealt with least cholelithiasis cases (7.66%). Table 1. Incidence of gallstone disease in Hyderabad and adjoining areas during 2002 to Hospitals Total surgeries Cholecystectomies Incidence (95% confidence intervals) Liaquat Universit y Hospital, Jamshoro ( ) Memon Charitable ( ) Wali Bhai Rajputana ( ) Naseem Medical Center, Hyd erabad ( ) Isra Universit y ( ) Overall ( ) 3

4 Females were more likely to be operated for cholelithiasis and this was consistent across all the hospitals except for Isra University Hospital. Male to female ratio in Liaquat University Hospital was higher (1:7.42) as compared to other hospitals, whereas reverse was true for Isra University Hospital (table 2). Table 2. Gender-wise incidence of cholecystectomy in Hyderabad and adjoining areas during 2002 to Hospitals Male (%) Female (%) Male:Female Liaquat Universit y Hospital, Jamshoro :7.42 Memon Charitable :1.86 Wali Bhai Rajputana :3.45 Naseem Medical Center, Hyderabad :3.29 Isra Universit y :0.51 Most (49.61%) of the gallstone patients were of years age while least belonged to the extreme age, that is from 14 years (0.545%) and 75 years (0.43%) (fig 1). Seasonal variation had no effect on the presentation of gallstone disease (fig 2). The frequency of cholecystectomy for females was increasing consistently from 2002 to 2005, whereas in males it was remained constant (fig 3). 4

5 DISCUSSION Incidence of cholecystectomy in Liaquat University Hospital, Isra University Hospital, and Memon Charitable Hospital.had increased by 2% when compared with the previous study. 7 There was only 1% increase in Naseem Medical Center and Wali Bhai Rajputana Hospital. Liaquat University Hospital is a government hospital and the highest percentages of surgeries (62.7%) were performed in that hospital, as reported earlier. 7 Fig 1. Age-wise comparison of gallstone patients undergone cholecystectomy with male to female ratio (1:5.33) 45-59(1:4.2) 15-29(1:2) 60-74(1:3) 14(1:1.2) 75(1:1.7) The frequency had greatly increased as compared to the study performed during , which was 9.03 %. 7 The possible reasons for increased surgical incidence may be: awareness in females for getting medical attention rather than to die with the disease, 8 more facilities to reach hospitals in time, 8 increased population in Pakistan, 9 frequent use of oral contraceptives, 10 and intake of poor quality of fat. 11 The overall prevalence of gallstone disease is lower in Asians (3% to 15%) and almost absent (less than 5%) in Africans. 12 5

6 Fig 2. Month-wise presentation of gallstone disease during Cases (%) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Among the five hospitals of Hyderabad, highest frequency (15.28%) was seen for Memon Charitable Hospital. According to our previous study, the highest surgical incidence (13%) was also seen for this Hospital. The residents of that location were great consumers of rapeseed oil. 11 Females are known to have a two-to three fold higher risk for gallstone disease than males. 13 Except for Isra University Hospital, the remaining four hospitals showed highest percentage of cholecystectomies in females. The predominance of females in Liaquat University Hospital might be due to the earlier mentioned factors. It is suggested that the main cause of such an increased frequency in females of that area as compared to other hospitals should further be studied at molecular levels. 6

7 Fig 3. Year-wise comparison of incidence of cholecystectomy Cases (%) Females Males The increased risk of cholelithiasis is dependent on age. 14 Our study showed highest prevalence in patients of years age and decreased above 60 years, as shown in other studies. 15,16 Since the higher risk for gallstone disease in women is primarily a phenomenon of the childbearing age, sex hormones and pregnancy are most likely to be responsible. 17 We have not found any peak season for the presentation of cholelithiasis. However previous work in this region reported that May followed by November was the peak months. 7 In conclusion, frequency of cholecystectomy has increased from 9.03% to 11.14% in Hyderabad and adjoining areas in period from 2002 to It was observed that the frequency of cholecystectomy for female gallstone patients was increasing regularly, whereas, for males it was constant. REFERENCES 1. Oettinger W. and K Orth. Cholecystectomy the gold standard of therapy. Langenbecks Arch Chir Suppl II Verh Dtsch Ges Chir. 1990;21:

8 2. Erichsen HG. Cholecystitis and cholelithiasis. Experience with 760 cases. Tidsskr.Nor Laegeforen. 1979;99: NIH Consensus conference. Gallstones and laparoscopic cholecystectomy. JAMA. 1993;269: Bateson MC. Gallstones and cholecystectomy in modern Britain. Postgrad. Med. J. 2000;76: Bartoli E, Capron JP. Epidemiology and natural history of cholelithiasis. Rev Prat. 2000;50: Khand FD, Ansari AF, Khand TU, Leghari MY, Samo MJ. Cholelithiasis in Southern Sindh (Pakistan): Incidence and composition of gallstones. Specialist. 1997;13: Channa NA, Khand FD, Bhanger MI, Laghari MH. Surgical incidence of cholelithiasis in Hyderabad and adjoining areas (Pakistan). Pak J Med Sci. 2004;20: Zheng J. Survey report: Pakistan. Popul Today. 1991;19: Population Association of Pakistan. Population windows, a quarterly news letter on population. Summer 2005;6: Kiani MF, Nazli S. Dynamics of birth spacing in Pakistan. Pak. Dev Rev. 1988;27:

9 11. Channa NA, Khand FD, Bhanger MI, Laghari MH. Cottonseed and /or Rapeseed oils intake and gallstone risk: Results from a case control study. Pak J Ana Chem. 2003;4: Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005;7: Volzke H, Baumeister SE, Alte D, Hoffmann W, Schwahn C, Simon P, et al. Independent risk factors for gallstone formation in a region with high cholelithiasis prevalence. Digestion. 2005;71: Chen CY, Lu CL, Huang YS, Tam TN, Chao Y, Chang FY, et al. Age is one of the risk factors in developing gallstone disease in Taiwan. Age Ageing , 27: Jensen KH, Jørgensen T. Incidence of gallstones in a Danish population. Gastroenterology. 1991;100: Attili AF, De Santis A, Capri R, Repice AM, Maselli S, GREPCO Group. The natural history of gallstones: the GREPCO experience. Hepatology. 1995;21: Novacek G. Gender and gallstone disease. Wein Oned Wochenschr. 2006;156: