Failed or difficult laparoscopic cholecystectomy: Can preoperative ultrasonography identify potential problems?

Abstract

A prospective study was performed to assess the role of preoperative ultrasonography in predicting failed or difficult laparoscopic cholecystectomy. Fifty patients underwent detailed preoperative ultrasound examinations. The number and size of calculi, evidence of acute or chronic cholecystitis, gallbladder morphology, and the presence or absence of aberrant anatomy were documented. A comparison was made of the surgical outcome and the ultrasound findings in each patient. Six patients were converted to open cholecystectomy because of inflammatory changes in the gallbladder. The preoperative ultrasound studies in 5 of these patients demonstrated evidence of cholecystitis and cholelithiasis. Gallbladder wall thickening and contraction were also seen. Five gallbladder resections had intraoperative difficulties; preoperative ultrasonography demonstrated a thickened gallbladder wall in 2. Of 31 uneventful cases, 7 had evidence of gallbladder wall thickening and/or contraction. There were no ultrasound features that identified between the unsuccessful, difficult, or uneventful laparoscopic cholecystectomies. We conclude that detailed preoperative ultrasound evaluation of the gallbladder in patients destined for laparoscopic cholecystectomy is of little value in screening for difficult or unsuitable cases.

Factors predicting difficult laparoscopic cholecystectomy: a single institution experience

“…8−11 However, one study gives opposite results for gallbladder wall thickness. 12 Present study shows that stone impaction at the gallbladder neck is a good predictor of difficulty in laparoscopic cholecystectomy, which is contrary to the findings in other studies in which stone impaction is shown to have a moderate correlation. 13 According to present study prior hospitalization, BMI>30, palpable gallbladder, thick gallbladder wall on USG were significant predictors of difficult laparoscopic cholecystectomy.…”

Proposed Diagnostic Scoring System to Predict Difficult Laparoscopic Cholecystectomy

“…Majeski James and N. Gupta et al found GB wall thickening to be associated with difficult LC [26] . But Carmody E et al and Agarwal et al did not found any significant association between them [27] . Randhawa et al gave 2 score while Acharya A. gave 2 score to gall bladder wall thickness more than 4 mm and 3 mm respectively.…”

Study of 292 patients for prediction of difficult laparoscopic cholecystectomy using detailed history, clinical and radiological parameters

“…The same results were obtained in other studies. [8][9][10][11][12][13] In our study we emphasize on history as there is linear correlation between duration of symptoms, silent or clinical attacks of cholecystitis and difficulty level of LC as each attack of cholecystitis increased the adhesion between GB and omentum, increased adhesion of calot's triangle and GB to its fossa.…”