Geographic variation in management of gall-stones


  • Hussain Taher Abbas Al-Qaddissiyah university


gallstone, obstructive jaundice



Prospective study that includes 200 cases of gall stones that operated randomly over two years in mesalata  central hospital in Libya (2007-2009).The patients are divided in two groups, early age group (17-39years) and middle, late age group(40-80 years).Most of cases at early adult life operated by prompt cholecystectomy

Results: 110 (55%) of cases are presented between 17-39 years, 63(31.5%) of them below 30 years ,59 (of these 63 cases) are females, 20% of them without risk factors while all the 4 male cases are with strong risk factor. 161(80.5%) of cases are females and 39(19.5%) of them are males .95(59%) of female cases between 18 -39 years, and 59(37%) before 30 years.

Obstructive jaundice is seen in 9(4.5%) cases of 200, 7(18 % of 39 male cases) cases of them are males. Acute pancreatitis are seen in 6 cases (3%), 4(2%, adjusted with gender) of them are females

Only one case (0.6%) of pancreatitis and other one case (o.6%) of obstructive jaundice are seen in females at early adult life.

2(1%) cases are presented with carcinoma of gallbladder

Symptomatic gallstone is disease of young females. Main risk factor of gallstone at early adult life is estrogen “the higher the estrogen for long time as in multiple pregnancies the more risk”. The other risk factors “except family factors” takes its rules later when the patient is more than 30 years old. Because we adopt the regime of prompt cholecystectomy in all cases of early adult life, the serious complication of disease is low (2%). The males cases are more likely to develop complications of obstructive jaundice than females.




1-Bruce D, cholelithiasis and cholecystitis. J. of long term effect of medical implant. 2005 .volume 15, issue 3: pages 329-338.
2-Margret O, al et. Schwartz principles of general surgery. Pages 1135-1146
3-Patrick G, al et. Sabiston textbook of surgery , the 18 edition 1476-1572.
4- Grant sanders BMG. 2007 Aug 11; 335(7614):295-9.
5-Attili AF, Di Santis A, Capri A, et. al. The natural history of gall stone. GREPCO experience: The GREPCO group. Hepatology. 1995; 21:655
6- Gracie WARansohoff DF The natural history of silent gallstones: the innocent gallstones are not a myth. N ENGL J Med. 1982; 307: 798-800
7-Mc Sherry The natural history of diagnosed gallstones disease in symptomatic and asymptomatic patients. Ann Surg. 1985; 20: 259-63.
8-Ransohoff DF Prophylactic cholecystectomy or expectant management for silent gallstones: a decision analysis to assess survival. Ann intern med.1983; 99: 199-204.
9-Ransohoff DF, Gracie WA. Treatment of gallstones. Ann Intern Med. 1993; 119((1)) 606-619.
10-Murshid KR. Symptomatic gallstones: A disease of young Saudi women. Saudi J Gastrointestinal, 1998; 4:159-162.
11- B. Abd all-Hassan. Changing pattern and incidence of gallstones disease in Al-kadhymia Teaching Hospital. Iraq JMS, 2011; vol.9 (2):176-183.
12-Nakeeb A, at el. Gallstones: genetics versus environment. Ann Surgery. 2002; 235: 842
13- Khalil T, Effect of aging on the gallbladder contraction and release of CCK in human .surgery, 1985; 98:423-429
14-Friedman GD Natural history of asymptomatic and symptomatic gallstones. Is J Surg. 1993; 16:165: 399-404?
15-Glasgow RE ET. al. The spectrum and cost of complicated gallstones disease in California. Arch surg 2000; 135(9): 1021-1025.
16- Lia TH, Patient’s evaluation and management with selective use of MRC and ERCP before lap cholecystectomy. Amm surg 2001, 234: 33-40.
17-Khan HN, 10 years follow up of longitudinal study of gallstones prevalence at necropsy in south east England dig dis sci. 2009 Jan, 54:2736-274.