CORRELATION OF ULTRASONOGRAPHIC FINDINGS IN PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE STUDY

Abstract

Background: Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. However, difficult laparoscopic cholecystectomy remains a challenge and may increase operative morbidity. Preoperative prediction of difficult cases using ultrasonography can aid in surgical planning and patient counseling.

Aim: To evaluate the correlation between preoperative ultrasonographic findings and intraoperative difficulty during laparoscopic cholecystectomy.

Materials and Methods: A prospective observational study was conducted in the Department of General Surgery, Sapthagiri Institute of Medical Sciences, Bengaluru, from January 2023 to August 2024. Forty patients with symptomatic cholelithiasis undergoing elective laparoscopic cholecystectomy were included. Ultrasonographic parameters assessed included gallbladder wall thickness, contracted gallbladder, and impacted stone at the gallbladder neck. Difficult laparoscopic cholecystectomy was defined as operative time greater than 90 minutes, presence of dense adhesions, or difficulty in Calot's triangle dissection. Data were analyzed using descriptive statistics and Chi-square/Fisher's exact tests.

Results: Among 40 patients, 34 (85%) were females and 6 (15%) were males. Ten patients (25%) underwent difficult laparoscopic cholecystectomy. Gallbladder wall thickness ≥4 mm was observed in 7 patients, of whom 6 (85.7%) had difficult surgery (χ2 = 16.68, p < 0.001). Contracted gallbladder was present in 4 patients and all experienced difficult surgery (χ2 = 13.33, p < 0.001). Impacted gallstone at the neck was present in 3 patients and all were associated with difficult surgery (χ2 = 9.73, p = 0.002). Ultrasonography demonstrated a sensitivity of 80% and a positive predictive value of 90.9%.

Conclusion: Gallbladder wall thickness ≥4 mm, contracted gallbladder, and impacted gallstone at the neck are significant ultrasonographic predictors of difficult laparoscopic cholecystectomy. Ultrasonography serves as a valuable preoperative tool for anticipating operative challenges.