Page 43 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Role of Preoperative Ultrasonography Findings in Predicting

Difficult Laparoscopic Cholecystectomy

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Sathishkumar Arone , Raghunath KJ , Venkatasubramanian R , Muralidharan M , Dakshay Chordia 5
Received on: 09 February 2022; Accepted on: 16 September 2022; Published on: 07 December 2022
AbstrAct
Aim: Most of the complications in a laparoscopic cholecystectomy are due to the difficulties faced during the surgery. In this research, the attempt
was made to determine the factors that can predict a difficult laparoscopic cholecystectomy preoperatively based on ultrasound findings.
Materials and methods: One hundred patients who are satisfied with our inclusion criteria were included in our study. Preoperative
ultrasonography (USG) findings like thickness and size of the gallbladder (GB) wall, the diameter of the common bile duct (CBD), GB stone size
and numbers, and the existence of fluid collection around the GB were given a grade of 1 or 0 based on findings being affirmative or dissent.
The sums of the grade were taken and were interrelated with the difficult laparoscopic cholecystectomy. Intraoperative findings, namely, injury
and damages made to the bile duct, CBD or artery, the existence of thick adhesions on the GB sides, region of the Calot’s being frozen, ripped
up GB and spillage of bile and stones, unusual and atypical anatomy, bleeding that hampers and obstructs the visual field, and time taken of
60–120 minutes were considered as difficult laparoscopic cholecystectomy.
Results: Four preoperative findings, namely, the thickness of GB, GB stone impacted at the neck, GB stone size, and the existence of fluid collection
around the GB had statistical significance in anticipating a difficult laparoscopic cholecystectomy. An elevated preoperative ultrasonography
score had shown higher chances of a difficult laparoscopic cholecystectomy.
Conclusion: Preoperative ultrasonography findings have a role in predicting a difficult laparoscopic cholecystectomy.
Clinical significance: Laparoscopic cholecystectomy will be useful to have some authentic factors (USG findings) to prognosticate difficulty,
conversion, or complications in laparoscopic cholecystectomy.
Keywords: Difficult laparoscopy, Gallbladder, Laparoscopic cholecystectomy, Prospective observational study, Ultrasonography.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1539

IntroductIon 1–5 Department of General Surgery, Apollo Hospitals, Chennai,
Cholecystectomy is one of the most frequently performed surgical Tamil Nadu, India
procedures and in many developed countries they are performed Corresponding Author: Sathishkumar Arone, Department of General
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laparoscopically. The rapid acceptance of this new technique by Surgery, Apollo Hospitals, Chennai, Tamil Nadu, India, Phone: +91
the medical profession and the public was related to the obvious 8667696404, e-mail: sathishkumaraaron@gmail.com
advantages of reduced cost, decreased hospital length of stay, How to cite this article: Arone S, Raghunath KJ, Venkatasubramanian R,
reduced morbidity, better cosmetic scar, and increased patient et al. Role of Preoperative Ultrasonography Findings in Predicting
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satisfaction. For these reasons, laparoscopic cholecystectomy Difficult Laparoscopic Cholecystectomy. World J Lap Surg 2022;15(3):
is now considered the gold standard surgical treatment of 229–234.
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choice for cholelithiasis. For cholecystitis and cholelithiasis, Source of support: Nil
ultrasonography screening is proven to be highly accurate, safe, Conflict of interest: None
and non-invasive.
Those patients who had a well-established disease and previous
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events of cholecystitis or pancreatitis are at increased risk of A difficult laparoscopic cholecystectomy is defined as when we
experiencing a difficult laparoscopic cholecystectomy. The overall address a difficult GB during the surgery. When a cholecystectomy
conversion rate, as reported in numerous series on laparoscopic causes an increased risk and complication when compared to the
cholecystectomy, varies from 3.2% to 5.3%. Laparoscopic standard cholecystectomy then it is known as a difficult GB. It can
cholecystectomy conversion rate increases from 15% to 20% be due to GB inflammation due to infection and other reasons or
in patients having acute cholecystitis. Presently, GB cancer and due to difficult exposure. Inflammation includes severe chronic
uncorrectable coagulopathy are the absolute contraindications cholecystitis and acute cholecystitis. Acute cholecystitis is the most
for laparoscopic cholecystectomy. 4 common cause of a difficult GB. It includes gangrenous cholecystitis,
It will be useful to have some authentic factors to prognosticate emphysematous cholecystitis, and perforated GB. Difficulty in
difficulty, conversion, or complications in laparoscopic exposure includes previous upper abdominal surgery and obesity.
cholecystectomy. Patients who are anticipated to have difficulty, Other conditions are liver cirrhosis and Mirizzi’s syndrome.
conversion, or complications can then be counseled about open In this study, we determine the factors which can predict a
surgery, complication, and prolonged hospital stay. In this way, difficult laparoscopic cholecystectomy preoperatively based on
the patients and their attendees will be prepared for the adverse ultrasound findings. This is done by validating the cut-off score
consequences. from ultrasonography formulated scoring and finding the most

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