A Cross Sectional Study To Determine Predictive Factors For Difficult Laparoscopic Cholecystectomy Using Ultrasonographic Criteria

Abstract

Background and objectives Ultrasonography is highly helpful characterizing the gallbladder appearance. The present study was undertaken to determine the role of ultrasonography in predicting difficult laparoscopic cholecystectomy and to correlate preoperative factors with intraoperative findings of laparoscopic cholecystectomy. Methodology This hospital based prospective study was conducted in the Department of General Surgery, KLES Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi from January 2016 to December 2016. A total of 60 patients presenting with right hypochondriac pain and diagnosed to have cholecystitis or cholelithiasis undergoing laparoscopic cholecystectomy were studied Results The male female ratio was 1.06:1 and 51.67% of the patients were males. The mean age was 47.62±10.35 years. Ultrasound findings showed 68.83% of the patients with multiple numbers of stones, 38.33% with stone size of ≥10 mm and 31.67% had gallbladder thickness of ≥4 mm. The gall bladder volume was contracted in 21.67% of the patients. Intra operative findings revealed difficult gall bladder extraction in 30.77% of the patients followed by stone spillage in 23.08% of the patients, bleeding in 15.38% of the patients, difficult Calot’s triangle dissection and gall bladder perforation in 11.54% each. Based on these observations, 43.33% of the patients had difficult laparoscopic cholecystectomy. Conversion from laparoscopic cholecystectomy to open cholecystectomy was noted in 11.67% of the patients. Significantly higher number of patients with difficult laparoscopy (26.92%) required conversion to open laparoscopic cholecystectomy (p=0.002). Also significantly higher number of patients with largest stone size of ≥10 mm (26.09%; p=0.010), gall bladder wall thickness of ≥4 mm (31.58%; p=0.003) and contracted gall bladder (38.46%; p=0.008) required conversion to open cholecystectomy. Conclusion and interpretation Hence, it may be concluded that, ultrasonographic finding namely, multiple numbers of stones, stone size of ≥ 10 mm, gall bladder thickness of ≥ 4 mm and contracted gall bladder volume help in predicting difficult laparoscopy.