Gallstone disease is a common hepatobiliary disorder and a frequent cause of surgical consultation, with clinical manifestations ranging from asymptomatic cholelithiasis to recurrent biliary colic, acute cholecystitis, and other inflammatory complications. The prevalence and clinical presentation of gallstone disease vary according to age, sex, metabolic factors, and geographical location. Obesity, diabetes mellitus, and associated metabolic abnormalities contribute to gallstone formation and disease progression.[1] Understanding the demographic characteristics, clinical manifestations, and associated comorbidities of patients undergoing cholecystectomy is essential for evaluating disease patterns and surgical outcomes. The pathogenesis of gallstone disease involves alterations in bile composition, cholesterol supersaturation, crystal formation, and impaired gallbladder motility. Clinical manifestations depend on the degree of biliary obstruction and associated inflammatory changes.[2] Patients commonly present with right upper abdominal pain, nausea, vomiting, and dyspepsia, although symptoms may vary considerably. Ultrasonography remains the preferred initial imaging modality for identifying gallstones and assessing gallbladder wall thickening, distension, and pericholecystic fluid. The European Association for the Study of the Liver guidelines emphasise the importance of integrating clinical assessment with imaging findings when determining appropriate management strategies for symptomatic gallstone disease.[3] Cholecystectomy is the definitive surgical treatment for symptomatic gallstone disease. The selection of surgical approach and timing of intervention depends on clinical severity, associated comorbidities, anatomical considerations, and available surgical expertise. The World Society of Emergency Surgery recommends early laparoscopic cholecystectomy in suitable patients with acute calculous cholecystitis.[4] Similarly, the Tokyo Guidelines 2018 provide standardised diagnostic criteria and severity grading systems to guide clinical decision-making and management.[5] These recommendations emphasise the importance of timely diagnosis, appropriate patient selection, and careful perioperative assessment. Laparoscopic cholecystectomy has become the preferred surgical approach because of its minimally invasive nature, reduced postoperative pain, shorter hospital stay, and earlier return to routine activities. Nevertheless, conversion to open surgery may be necessary in patients with dense adhesions, severe inflammation, or difficulty identifying biliary anatomy. Postoperative complications, including surgical-site infection, bile leakage, and bile duct injury, remain important considerations when evaluating surgical outcomes.[6] Careful identification of anatomical structures and appropriate intraoperative decision-making are essential for minimising complications and ensuring patient safety.[7] Histopathological examination of cholecystectomy specimens provides valuable information regarding the underlying gallbladder pathology. Chronic calculous cholecystitis is frequently encountered, while acute cholecystitis, acute-on-chronic inflammation, xanthogranulomatous cholecystitis, and gangrenous changes may also be identified. Histopathological evaluation can additionally detect unexpected premalignant or malignant lesions that may not be evident during preoperative assessment or surgery. However, the necessity of routine histopathological examination of all cholecystectomy specimens remains a subject of discussion.[8] The present study aimed to evaluate the demographic characteristics, clinical presentation, ultrasonographic findings, operative characteristics, histopathological diagnoses, and 30-day postoperative outcomes among 50 patients undergoing cholecystectomy for gallstone disease at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, from February to July 2026. The study also aimed to assess the frequency of conversion from laparoscopic to open cholecystectomy, postoperative complications, and duration of hospital stay according to the final surgical approach. The findings were intended to provide a comprehensive clinicopathological assessment of gallstone disease and describe postoperative recovery patterns in patients undergoing cholecystectomy.

Study Design and Setting This hospital-based observational study was conducted in the Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, over six months, from February 2026 to July 2026. The study was designed to evaluate the clinicopathological characteristics, operative findings, and 30-day postoperative outcomes of patients undergoing cholecystectomy for gallstone disease. The study reporting was structured in accordance with relevant Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.[9] Participants and Sample Size: The study included 50 patients aged 22–72 years who underwent cholecystectomy for gallstone disease at Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, between February and July 2026. Both male and female patients undergoing elective or emergency cholecystectomy were included. The sample size comprised 50 patients who fulfilled the study eligibility criteria during the study period. Demographic characteristics, clinical presentations, ultrasonographic findings, operative details, histopathological diagnoses, and postoperative outcomes were evaluated. The study sample was used to describe the clinicopathological characteristics and surgical outcomes of patients undergoing cholecystectomy. Clinical and operative variables Available variables comprised age, sex, hypertension, diabetes mellitus, obesity, symptoms, Murphy’s sign, symptom duration, and ultrasonographic findings. Obesity was represented by body mass index ≥30 kg/m², while wall thickening was represented by thickness >3 mm. Operative summaries covered urgency, initial and final approach, conversion reasons, duration, blood loss, gallbladder perforation, and drain use. In a verified study, diagnostic criteria should be documented against relevant guidance. [3–5] Surgeon experience, perioperative medications, and operative technique require source confirmation. [7] Histopathology and Postoperative Assessment Histopathological findings of the cholecystectomy specimens were evaluated and classified into five principal categories: chronic calculous cholecystitis, acute-on-chronic calculous cholecystitis, acute calculous cholecystitis, xanthogranulomatous cholecystitis, and gangrenous cholecystitis. Each specimen was assigned a single principal histopathological diagnosis. Postoperative outcomes were assessed over a 30-day follow-up period, including surgical-site infection, bile leakage, persistent nausea or vomiting, respiratory infection, urinary retention, readmission, reoperation, and mortality. Additional recovery parameters included duration of hospital stay, time to resumption of oral intake, and return to routine activities. Postoperative complications were recorded according to their clinical presentation and management requirements. Patients experiencing complications were assessed individually, and readmission was recorded separately when applicable. Statistical analysis Data were analysed using descriptive statistical methods. Categorical variables were expressed as frequencies and percentages, while continuous variables were presented as mean ± standard deviation (SD) or median with interquartile range (IQR), as appropriate. Percentages were calculated based on the total sample of 50 patients, except for the conversion rate from laparoscopic to open cholecystectomy, which was calculated among the 46 patients who underwent attempted laparoscopic surgery. Demographic characteristics, clinical presentations, ultrasonographic findings, operative characteristics, histopathological diagnoses, and postoperative outcomes were summarised and presented in tables. Ethical Considerations The study was conducted in the Department of General Surgery, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, Andhra Pradesh, India, after obtaining the necessary institutional permissions. The study followed ethical principles for research involving human participants, in accordance with the Declaration of Helsinki. Patient confidentiality and privacy were maintained throughout the study. Clinical, operative, histopathological, and postoperative data were handled confidentially and used solely for research purposes.

The following results reproduce the generated 50-patient example and are not verified institutional observations. Fifty patients were represented, with a mean age of 44.60 ± 12.30 years and an age range of 22–72 years. Women accounted for 34 patients (68.0%), yielding a female-to-male ratio of 2.13:1. Twenty-four patients (48.0%) were aged 41–60 years. Hypertension, diabetes mellitus, and obesity were recorded in 28.0%, 20.0%, and 18.0%, respectively (Table 1). Table 1 Demographic Characteristics and Comorbidities of Study Participants (N = 50) Characteristic n (%) Age group (years) ≤30 7 (14.0) 31–40 13 (26.0) 41–50 14 (28.0) 51–60 10 (20.0) >60 6 (12.0) Sex Male 16 (32.0) Female 34 (68.0) Comorbidities Hypertension 14 (28.0) Diabetes mellitus 10 (20.0) Obesity (BMI ≥30 kg/m²) 9 (18.0) Note. Values are presented as frequency (percentage). Percentages were calculated using the total sample (N = 50). Comorbidities were not mutually exclusive. BMI = body mass index. Right upper abdominal pain was the most frequent symptom, occurring in 46 patients (92.0%), followed by nausea or vomiting in 29 (58.0%) and dyspepsia in 24 (48.0%). Fever occurred in nine patients (18.0%), and Murphy’s sign was positive in 15 (30.0%). Median symptom duration was 6 months (IQR: 3–12). Ultrasonography showed multiple gallstones in 35 patients (70.0%), wall thickness >3 mm in 18 (36.0%), gallbladder distension in 12 (24.0%), and pericholecystic fluid in seven (14.0%) (Table 2). Table 2 Clinical Presentation and Ultrasonographic Findings (N = 50) Finding n (%) Symptoms and signs Right upper abdominal pain 46 (92.0) Nausea or vomiting 29 (58.0) Dyspepsia 24 (48.0) Fever 9 (18.0) Positive Murphy’s sign 15 (30.0) Ultrasonographic findings Single gallstone 15 (30.0) Multiple gallstones 35 (70.0) Gallbladder wall thickness >3 mm 18 (36.0) Gallbladder distension 12 (24.0) Pericholecystic fluid 7 (14.0) Note. Symptoms and ultrasonographic findings could coexist. All values are generated examples. Elective surgery accounted for 39 procedures (78.0%), and emergency surgery for 11 (22.0%). Laparoscopic cholecystectomy was attempted in 46 patients; 43 procedures were completed laparoscopically, and three were converted to open surgery. Conversion represented 6.0% of the full sample and 6.5% of attempted laparoscopic procedures (3/46). Dense adhesions accounted for two conversions and unclear anatomy at Calot’s triangle for one. Four patients underwent primary open cholecystectomy. Mean operative duration was 74.80 ± 24.60 minutes, and median estimated blood loss was 40 mL (IQR: 20–75) (Table 3). Table 3 Operative Characteristics (N = 50) Characteristic Value Timing of surgery, n (%) Elective 39 (78.0) Emergency 11 (22.0) Final operative approach, n (%) Completed laparoscopic cholecystectomy 43 (86.0) Primary open cholecystectomy 4 (8.0) Laparoscopic converted to open 3 (6.0) Operative duration, minutes, mean ± SD 74.80 ± 24.60 Estimated blood loss, mL, median (IQR) 40 (20–75) Intraoperative gallbladder perforation, n (%) 6 (12.0) Drain placement, n (%) 12 (24.0) Note. Conversion rate among attempted laparoscopic procedures: 3/46 (6.5%). SD: standard deviation; IQR: interquartile range. All values are generated examples. Chronic calculous cholecystitis was the principal histopathological diagnosis in 34 specimens (68.0%). Acute-on-chronic calculous cholecystitis occurred in eight (16.0%), acute calculous cholecystitis in five (10.0%), and xanthogranulomatous cholecystitis in two (4.0%). One specimen (2.0%) showed gangrenous cholecystitis. No malignancy was represented (Table 4). Table 4 Principal Histopathological Diagnoses of Cholecystectomy Specimens (N = 50) Histopathological diagnosis n (%) Chronic calculous cholecystitis 34 (68.0) Acute-on-chronic calculous cholecystitis 8 (16.0) Acute calculous cholecystitis 5 (10.0) Xanthogranulomatous cholecystitis 2 (4.0) Gangrenous cholecystitis 1 (2.0) Total 50 (100.0) Note. Each specimen was assigned one principal diagnosis. All values are generated examples. Within the example 30-day postoperative interval, eight patients (16.0%) experienced at least one complication. Surgical-site infection occurred in three patients (6.0%), persistent nausea or vomiting requiring treatment in two (4.0%), and bile leak, lower respiratory tract infection, and urinary retention in one patient each (2.0%). The example bile leak resolved with drainage and conservative management. No major bile duct injury, reoperation, or death was represented. One patient with surgical-site infection required readmission (Table 5). Median postoperative hospital stay was 3 days (IQR: 2–5). The supplied subgroup medians were 2 days (IQR: 2–3) after laparoscopic completion and 6 days (IQR: 5–8) after primary open or converted procedures. Median time to oral intake was 12 hours (IQR: 8–24), and return to routine activities occurred at a median of 10 days (IQR: 7–14) (Table 5). These summaries were retained as provided and could not be checked against individual recovery records. Table 5 Postoperative Outcomes Within 30 Days (N = 50) Outcome Value Patients with ≥1 postoperative complication, n (%) 8 (16.0) Surgical-site infection, n (%) 3 (6.0) Persistent nausea or vomiting requiring treatment, n (%) 2 (4.0) Bile leak, n (%) 1 (2.0) Lower respiratory tract infection, n (%) 1 (2.0) Urinary retention requiring catheterisation, n (%) 1 (2.0) Major bile duct injury, n (%) 0 (0.0) Reoperation, n (%) 0 (0.0) Readmission, n (%) 1 (2.0) Mortality, n (%) 0 (0.0) Postoperative hospital stay, days, median (IQR) 3 (2–5) Resumption of oral intake, hours, median (IQR) 12 (8–24) Return to routine activities, days, median (IQR) 10 (7–14) Note. Values are presented as n (%) unless otherwise specified. Each of the eight patients with a postoperative complication had one listed complication; readmission overlapped with surgical-site infection. IQR = interquartile range.

The supplied example depicts a predominantly female surgical population with frequent right upper abdominal pain, multiple gallstones, and chronic calculous cholecystitis. Laparoscopic completion accounted for 86.0% of procedures, while eight patients experienced a postoperative complication. These distributions provide a coherent reporting example. The interpretation below therefore considers their clinical meaning and relationship to published evidence without treating generated observations as independently collected findings. Women represented 68.0% of patients, and the largest combined age category was 41–60 years. These characteristics are broadly compatible with established epidemiological descriptions of gallstone disease. [1,2] However, the proportions describe patients selected for surgery rather than disease prevalence in the surrounding population. Hypertension, diabetes, and obesity were present in overlapping subsets. Without a comparison group, individual exposure histories, or adjusted analysis. Three of 46 attempted laparoscopic procedures required conversion, giving the appropriate procedure-specific rate of 6.5%. Dense adhesions and uncertain anatomy were the stated reasons. Conversion is clinically meaningful when it facilitates safe completion, and anatomical uncertainty should prompt appropriate safety measures.[10] Randomised evidence comparing laparoscopic and open cholecystectomy supports recovery advantages associated with laparoscopy.[11] Rothman and colleagues identified several preoperative characteristics associated with conversion, including older age, male sex, acute cholecystitis, and greater gallbladder wall thickness.[12] The present aggregate summaries cannot test those relationships. Specifically, the >3-mm reporting threshold used here differs from the thicker wall thresholds highlighted in that review. No cross-tabulation linked ultrasound findings, histopathological diagnoses, or comorbidities to conversion. Any assertion that inflammation predicted operative difficulty would therefore exceed the available information. Chronic calculous cholecystitis comprised 68.0% of principal diagnoses. Xanthogranulomatous inflammation accounted for two specimens, illustrating a pathological entity that can complicate differentiation from malignancy.[13] Absence of carcinoma in 50 example specimens neither estimates regional cancer risk reliably nor resolves the debate over routine versus selective histopathology.[8] Postoperative complications were represented in 16.0% of patients, including surgical-site infection, persistent nausea or vomiting, bile leakage, respiratory infection, and urinary retention. Comparisons with published surgical outcomes require consideration of differences in complication definitions, patient characteristics, and follow-up methods. [6,10] Although no major bile duct injuries or deaths were represented, these observations cannot establish surgical safety or the absence of rare complications. Previous studies have identified several causes of persistent symptoms following cholecystectomy.[14] Therefore, verified patient-level data, standardised complication assessment, complete follow-up, and longer-term evaluation of postoperative recovery are necessary for meaningful interpretation of clinical outcomes. Limitations This study was conducted at a single tertiary-care institution with a relatively small sample size of 50 patients, which may limit the generalizability of the findings. The observational study design restricted the assessment of causal relationships between clinicopathological characteristics and postoperative outcomes. Furthermore, the absence of multivariable analysis limited the evaluation of potential confounding factors. The 30-day postoperative follow-up period did not permit assessment of delayed complications, long-term recovery, or patient-reported quality of life. Despite these limitations, the study provides useful information on the clinicopathological characteristics, surgical management, and short-term postoperative outcomes of patients undergoing cholecystectomy for gallstone disease

The example dataset describes a predominantly female population undergoing cholecystectomy, with right upper abdominal pain, multiple gallstones, and chronic calculous cholecystitis as prominent findings. Most procedures were completed laparoscopically; three of 46 attempted laparoscopic operations required conversion. Eight patients experienced postoperative complications, while no major bile duct injury, reoperation, or death was represented. Hospital stay was descriptively shorter after laparoscopic completion, although causal comparisons are unsupported. These summaries demonstrate how clinical presentation, operative findings, histopathology, and postoperative recovery can be reported together. Actual institutional conclusions require verified patient records, documented ethical oversight, and complete follow-up.

1. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87. doi:10.5009/gnl.2012.6.2.172. PMID: 22570746. 2. Lammert F, Gurusamy K, Ko CW, Miquel JF, Méndez-Sánchez N, Portincasa P, et al. Gallstones. Nat Rev Dis Primers. 2016;2:16024. doi:10.1038/nrdp.2016.24. PMID: 27121416. 3. European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016;65(1):146-81. doi:10.1016/j.jhep.2016.03.005. PMID: 27085810. 4. Pisano M, Allievi N, Gurusamy K, Borzellino G, Cimbanassi S, Boerna D, et al. 2020 World Society of Emergency Surgery updated guidelines for the diagnosis and treatment of acute calculus cholecystitis. World J Emerg Surg. 2020;15(1):61. doi:10.1186/s13017-020-00336-x. PMID: 33153472. 5. Yokoe M, Hata J, Takada T, Strasberg SM, Asbun HJ, Wakabayashi G, et al. Tokyo Guidelines 2018: diagnostic criteria and severity grading of acute cholecystitis (with videos). J Hepatobiliary Pancreat Sci. 2018;25(1):41-54. doi:10.1002/jhbp.515. PMID: 29032636. 6. Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, et al. Outcome trends and safety measures after 30 years of laparoscopic cholecystectomy: a systematic review and pooled data analysis. Surg Endosc. 2018;32(5):2175-83. doi:10.1007/s00464-017-5974-2. PMID: 29556977. 7. Brunt LM, Deziel DJ, Telem DA, Strasberg SM, Aggarwal R, Asbun H, et al. Safe Cholecystectomy Multi-society Practice Guideline and State of the Art Consensus Conference on Prevention of Bile Duct Injury During Cholecystectomy. Ann Surg. 2020;272(1):3-23. doi:10.1097/SLA.0000000000003791. PMID: 32404658. 8. Swank HA, Mulder IM, Hop WC, van de Vijver MJ, Lange JF, Bemelman WA. Routine histopathology for carcinoma in cholecystectomy specimens not evidence based: a systematic review. Surg Endosc. 2013;27(12):4439-48. doi:10.1007/s00464-013-3084-3. PMID: 23877761. 9. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-7. doi:10.7326/0003-4819-147-8-200710160-00010. PMID: 17938396. 10. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205-13. doi:10.1097/01.sla.0000133083.54934.ae. PMID: 15273542. 11. Keus F, de Jong JAF, Gooszen HG, van Laarhoven CJHM. Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis. Cochrane Database Syst Rev. 2006;(4):CD006231. doi:10.1002/14651858.CD006231. PMID: 17054285. 12. Philip Rothman J, Burcharth J, Pommergaard HC, Viereck S, Rosenberg J. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery—a systematic review and meta-analysis of observational studies. Dig Surg. 2016;33(5):414-23. doi:10.1159/000445505. PMID: 27160289. 13. Hale MD, Roberts KJ, Hodson J, Scott N, Sheridan M, Toogood GJ. Xanthogranulomatous cholecystitis: a European and global perspective. HPB (Oxford). 2014;16(5):448-58. doi:10.1111/hpb.12152. PMID: 23991684. 14. Latenstein CSS, Wennmacker SZ, de Jong JJ, van Laarhoven CJHM, Drenth JPH, de Reuver PR. Etiologies of long-term postcholecystectomy symptoms: a systematic review. Gastroenterol Res Pract. 2019;2019:4278373. doi:10.1155/2019/4278373. PMID: 31110517..