The Role of Pre-Op Ultrasound Abdomen in Predicting Perioperative Difficulties in Gallstone Disease
Journal Title: Scholars Journal of Applied Medical Sciences - Year 2017, Vol 5, Issue 11
Abstract
Abstract: Ultrasound (USG) abdomen is an important diagnostic modality in the diagnosis of gallstone disease. The present study aims to determine reliable pre-operative ultrasonographic parameters which may predict the degree of difficulty in performing laparosccopic cholecystectomy.This study presents analysis of 100 consecutive cases of cholelithiasis undergoing elective cholecystectomy at Department of Surgery, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P) during the period of one year from November 2012 to November 2013 studied in a prospective manner. The patients were fasting overnight for the maximal distention of the gallbladder. The pre-operative ultrasonography was done with 3.5 Mhz probe on Diasonics spectra colour 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). Eighteen (18%) patients with gallbladder wall thickness more than 4 mm. There were eighteen (18%) patients with contracted gallbladder, and the remaining 82 patients had either gallbladder of normal volume that is approx. 50 ml or more. Six (6 %) patients with gallstone impacted at the neck of gallbladder or Hartman's pouch. Only 2 patients had common bile duct diameter greater than 6 mm. Out of total 100 cases, nine (9%) cases were converted to open procedure. Significant correlation was found between the independent ultrasonographic 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.Pre-operative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases and should be used, as a screening procedure. The most valuable assessment the ultrasound can give is 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, open cholecystectomy, USG
Authors and Affiliations
Shrivastava Prashant, Yadav Jitendra MS, Singal Ankur, Gupta Achal, Anand T anmay
Keywords
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