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.