Ultrasound findings in predicting difficult laparoscopic cholecystectomy

Background: Multiple technical intra-operative problems that raise the risk of complications and greatly lengthen the operating time are referred to as difficult laparoscopic cholecystectomy (LC).

Aim: to assess preoperative ultrasound (US) findings that indicate a difficult (LC) and the potential benefits for improvement of patient care.

Patients and method:100 patients underwent LC over a period of 9 months. Of these, 74 were female and 26 were male. Abdominal US was performed 48 hours prior to the surgery. The gallbladder (GB) wall thickness, GB size, gallstone (GS) multiplicity, GS mobility, GB empyema, and presence of pericholecystic fluid are the six parameters that were examined by ultrasound. The surgical procedure was rated as easy or difficult based on some surgical parameters, these include the length of the procedure, the occurrence of intraoperative bleeding, and the presence of significant adhesions or inflammation surrounding the GB and the Calot's triangle that obscure the dissection planes. The results of the ultrasound and the operation were compared.

Results: According to the statistical analysis, all ultrasound parameters were significantly correlated with the degree of surgical difficulty. 21 of the patients had a difficult laparoscopic cholecystectomy; of them, 2 had an open procedure performed because of severe adhesion. When predicting a difficult laparoscopic cholecystectomy, the thick wall gallbladder > 3mm has the highest sensitivity (83.3%) and the presence of pericholecystic fluid or empyema has the highest specificity (100%).

Conclusion: preoperative ultrasound results can be useful in anticipating problems that may arise during LC and necessitate conversion to open cholecystectomy (OC).