Relation between Gallbladder Wall Thickness, Assessed by Sonography, and Difficulties in Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallbladder disease. Preoperative prediction of a difficult laparoscopic cholecystectomy can help the surgeon to prepare better for intraoperative risk and the risk of conversion to open cholecystectomy. Objectives: Evaluation of the influence of gallbladder wall thickness, assessed by sonography preoperatively, on the outcome of laparoscopic cholecystectomy and to evaluate any intra-or postoperative complications in relation to them. Patients and Methods: This prospective clinical trial conducted in Department of Surgery, Al-yarmouk Teaching Hospital, between October 2010 and October 2012.Abdominal sonography performed in 122 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic findings in the operating room. Difficulty of laparoscopy was evaluated with multiple parameters related to the gall bladder wall thickness, so classified as easy or difficult laparoscopy or conversion. Results: Out of 122 patients with cholecystolithiasis on sonography, we encountered straight forward laparoscopic cholecystectomy in 87 patients (71.31%), difficult laparoscopic cholecystectomy in 27 (22.13%) and the procedure was converted to open cholecystectomy in 8 patients (6.55%). 47 patients(38.5%) had sonography revealing gallbladder wall thickness (>3 mm), and 75 patients (61.47%) had wall thickness < 3mm . Conclusions: Gallbladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to Laparotomy.