Forecast of difficult Laparoscopic cholecystectomy by Sonography: An added advantage

Forecast of a difficult operation can help the surgeon as well as the patient to prepare better for any intra-operative risk and its effective management. This was a prospective study conducted from June 2008 to july 2011 that included 298 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. Our entire series consisted of 298 patients, in whom 270 patients were operated laparoscopically, with 28 patients converted to open cholecystectomy. Patient data were analysed by univariate and multivariate analysis, using conversion to open cholecystectomy (OC) as a dependent variable. In 28 of 298 patients (9.4%), LC was converted to OC. In the univariate analysis, contracted gallbladder (< 5cm; Odds Ratio [OR] 0.776 95% confidence intervals [CI] 0.25 – 2.44), stone impaction (OR 2.6: 95% CI 1.12 – 5.1), thickened gall bladder wall (OR 3.81: 95% CI 1.11 – 13.11), and cholecystitis (OR 4.4: 95% CI 1.2 – 15.9) were able to predict pre-operatively the need for conversion. Logistic regression analysis defined only the sonographic sign of gall bladder thickness greater than 3 mm as a predictor of conversion. Ninty eight, out of total 298 patients, had gallbladder wall thickness of greater than 3 mm by preoperative ultrasonography and of these 46 (46.9%) had difficulty in dissection per-operatively and 20 (20.4%) underwent conversion to an open cholecystectomy. A preoperative ultrasonographic evaluation for symptomatic cholelithiasis, which shows a thick gallbladder wall (≥3 mm) with calculi, is a sign of caution clinically for likely a difficult laparoscopic cholecystectomy procedure which may require conversion to an open cholecystectomy procedure. These results revealed that conversion to open cholecystectomy can be predicted preoperatively. Laparoscopic conversion to open cholecystectomy also depends upon multiple factors like who have acute cholecystitis, multiple adhesion ; however, the correlation between its clinical and pathologic diagnosis is poor. Radiological excellance in ability to determine the risk for conversion have paramount importance and implications for surgical care