Role of Ultrasonography in Prediction of Technical Difficulties in Laparosopic Cholecystectomy - Clinical Research

Abstract

Background: Laparoscopic surgery widely, known as single incision laparoscopic cholecystectomy (LC), has been proved as the gold standard surgical technique and is now considered the treatment of choice as well as preferred surgical technique in cholecystectomy. The use of laparoscopic technique in cholecystectomy is widely used for cholelithiasis patients. An abdominal ultrasonography (USG) often precedes this surgery and can verify the diagnosis, as well as help in showing possible complications during the perioperative period. Aim: A prospective study was conducted to evaluate the pre-operative with and without (based on clinical fi ndings) USG fi ndings and predictive diffi culties in cholelithiasis patients comparing with surgical fi ndings in LC. The post-operative evaluating criteria were as follows: (1) Duration of surgery, (2) Bleeding, (3) Dissection of Calot's triangle, (4) Dissection of gallbladder wall, (5) Spillage of bile and stone, (6) Diffi culty of gall bladder stone. Methods: We studied and evaluated surgical diffi culties in 150 patients of cholelithiasis who underwent abdominal USG test for surgical LC. Variables such as identifi cation and amount of gallstones involved were evaluated, both in preoperative USG and during surgery to evaluate sensitivity, specifi city, concordance and positive and negative predictive values. All patients had routine blood tests (including liver function tests), electrocardiography, chest X-ray, and abdominal ultrasound scan performed preoperatively. All patients received general anesthesia, and the standard Reddick and Olsen technique was performed. The harmonic scalpel was used in all cases. Results: On evaluation of surgical diffi culties in cholelithiasis patients, we found 135 females and 15 males for surgical LC. Out of which 36 (24.0%) cases to be predicted as diffi cult, 26 (17.33%) were laparoscopic converted for open surgery, 36 (24.0%) were technically diffi cult. 54 (36.0%) cases were predicted easy to perform on USG. On evaluation, our fi ndings were found to be signifi cant, and hence, we concluded that pre-operative ultrasound examination if of importance for predicting diffi culties in LC, but still required further studies.

Assessment of Risk Factors for Conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy

“…Impacted stones at Hartmann's pouch makes dissection difficult because of difficulty in holding GB at Hartmann's pouch. Husain et al (24) found that stone size more than 1 cm was a significant factor for difficult and very difficult LC with P value <0.05.…”

Pre-Operative Score Development: Predicting Difficulty in Elective Laparoscopic Cholecystectomy

“…The forceps, with large jaws, must be used to grasp or suture the GB wall to extract or cut off a part of the GB wall, and then firmly pull it. Thickened GB is a risk factor for difficult LC 2,18 and conversion to open cholecystectomy [7][8][12][13] . The thickened GB had the highest predictive value in predicting the difficulty of LC; additionally, it was a significant predictor in the prediction model.…”