A CROSS-SECTIONAL STUDY FOR FORECASTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY THROUGH ULTRASONOGRAPHIC EVALUATION

Abstract

Introduction: There are several indications for performing a cholecystectomy, the most common of which is symptomatic cholelithiasis, also known as "biliary colic. Laparoscopic cholecystectomy is considered as the gold standard procedure for the definitive management of gallstones and other gallbladder diseases. Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis. However, the optimal timing of the procedure remains a topic of debate. Early laparoscopic cholecystectomy (ELC) has been shown to provide better clinical outcomes than delayed laparoscopic cholecystectomy (DLC) in cases of acute cholecystitis. One notable risk during LC is the potential need to convert to open cholecystectomy, particularly in patients with comorbid conditions, advanced age, a history of abdominal surgery, or low serum albumin levels. Research indicates that ELC is a safe approach that can reduce hospital stays and healthcare costs compared to DLC. Ultrasonography is the preferred imaging method for detecting gallstones and other gallbladder diseases and is also effective for monitoring the progression of cholecystitis and other gallbladder diseases. Surgical procedures can vary in complexity  from straightforward cases with clearly defined Calot’s triangle to more challenging ones with obscured anatomy, which may necessitate conversion to an open surgery

Objective of the study

• The use of pre-operative ultrasonographic findings in patients with chronic calculous cholecystitis and other gallbladder diseases to predict potential challenges during laparoscopic cholecystectomy and to correlate these pre-operative findings with intra-operative observations

Materials and methods: Sixty one patients with gallbladder diseases requiring laproscopic cholecystectomy attending the outpatient department and admitting at wards of General Surgery at RAICHUR INSTITUTE OF MEDICAL SCIENCES,RAICHUR, during the period 1^st November  2024 to May 30^th 2025, were  selected and evalvated clinically, heamatologically and radiologically in collabaration with radiology department and then patients were operated. Preoperative ultrasonographic parameters were recorded, including gallbladder size, wall thickness, gallstone number and mobility, and common bile duct diameter. Intraoperative parameters such as total operation time, dissection time of Calot’s triangle, gallbladder stripping time, any difficulties during extraction or spillage, and the need for conversion to open surgery were also documented

Results: In the current study, ultrasound findings predicted an easy surgery in 63.3% of patients and a difficult surgery in 37.7%. Among those with ultrasound reports indicating a difficult surgery, 22 patients indeed experienced difficult procedures, while only 2 did not—a statistically significant association (p = 0.001).

For gallbladder wall thickness, the positive predictive value (PPV) was 91.5%, with a sensitivity of 65% and specificity of 97%. In the case of a contracted gallbladder, the PPV was 95% (p = 0.002). Additionally, the PPVs for stone impaction and common bile duct (CBD) dilatation were 96% and 100%, respectively

Interpretation &Conclusion: Preoperative ultrasonography can serve as an effective screening tool for anticipating potential difficulties during laparoscopic cholecystectomy. In many cases, it reliably predicts the level of surgical complexity. This information can help the surgeon better prepare for the specific challenges that may arise with each patient