Prediction of the difficulties of Laparoscopic Cholecystectomy and the possibility of conversion to Open Cholecystectomy before surgery using Ultrasonographic criteria

Abstract

Background: Various other pre operative ultrasonographic parameters have been studied for predicting a difficult laparoscopic cholecystectomy. One of the most extensively studied parameters is gallbladder wall thickness. Objective: to predict the difficulties of LC and the possibility of conversion to OC before surgery using ultrasonographic criteria in our hospital Materials and methods:This study was carried out in the Department of General Surgery, Govt. Royapettah Hospital, attached to Govt. Kilpauk Medical College, Chennai for a period of duration of 7 months from February 2018 to August 2018.Results: Total number of cases in our study was 98. The mean gall bladder wall thickness in our study was found to be 3.19 mm. The maximum gall bladder wall thickness was 6 mm, whereas the minimum was found to be 1.8 mm. 20 patients had a gall bladder wall thickness of >4 mm. Moderate intra operative bleeding was seen in 4 patients. The remaining 94 patients only had mild bleeding. There were 20 (20.41%) patients with a duration of surgery >120 minutes. There were 23 (24.21%) patients with time to dissect gall bladder bed >20 minutes and 13(13.68%) patients for whom it took >20 minutes to dissect Calots triangle in our study. Conclusion:Pre operative ultrasonography is a good indicator of difficulties which may be faced intra operatively by the surgeon. Increase in gall bladder wall thickness, presence of impaction of stone at the neck of the gall bladder and aberrant morphology of the gall bladder and of the Calots triangle.