Difficult Laparoscopiic Cholecystectomy-Can Pre-Operative Ultrasound Predict?
Journal Title: Saudi Journal of Medical and Pharmaceutical Sciences - Year 2017, Vol 3, Issue 11
Abstract
Abstract:Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. It is easy, non invasive, and safe and a highly accurate imaging technique that can also detect associated lesions of the liver, pancreas and common bile duct (CBD). Recent studies have demonstrated that laparoscopic removal of gallbladder may be accomplished with a morbidity and mortality rate comparable to or less than that of traditional open cholecystectomy. The present study was conducted to look for some predictive factors on ultrasonography of gallbladder that can give surgeon some idea about the potential difficulty and complications that may be encountered during the course of laparoscopic cholecystectomy.This study presents analysis of 51 patients of cholelithiasis, requiring elective cholecystectomy from 1st May 2008 to 30th April 2009. The study was conducted in the Department of Surgery and Department of Radio diagnosis, G.R. Medical College, Gwalior (M.P.). The ultrasonography of the patients was done on the day of surgery in the department of Radio diagnosis, G.R. Medical College, Gwalior. The patients were fasting overnight for the maximal distention of the gallbladder. The ultrasonography was done with 3.5 Mhz probe on Diatonic spectra color Doppler ultrasound on B mode, gray scale, real time scan.The mean gallbladder wall thickness in the study was 2.9 mm (maximum - 5.6 mm and minimum – 1.8 mm). There were 8 patients who had gallbladder wall thickness more than 4 mm. There were 7 (13.2%) patients with contracted gallbladder. There were 6 (11.76 %) patients with gallstone impacted at the neck of gallbladder or Hartman's pouch. There were only 2 patients with common bile duct diameter more than 6 mm. Out of total 51 cases 7 (13.72%) cases were converted to open procedure. Significant correlation was found between the independent ultra-sonographic parameters (that is gallbladder wall thickness, contracted gallbladder, stone impaction at the neck of gallbladder) with the difficult laparoscopic cholecystectomy and their subsequent conversion to open cholecystectomy.The most valuable assessment the ultrasound can provide is the gall bladder wall thickness, gall bladder size, CBD diameter and CBD stones and any abnormal anatomy of the biliary tract if present. Thick gallbladder wall is a finding, which may show that more adhesions may be found during surgery. Keywords:Laparoscopic cholecystectomy (LC), open cholecystectomy (OC), USG
Authors and Affiliations
Singh Charan, Shrivastava Prashant, Singal Ankur, Gupta Achal
Keywords
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