Role of Ultrasonography (USG) in Evaluation of Pericholecystic Adhesions in Gallstone Disease (GSD)

Abstract

Background: In the recent era of laparoscopic and robotic surgeries, preoperative imaging has become very crucial in selecting the right operative technique in any pathological condition. Though laparoscopic cholecystectomy is widely accepted and practiced surgical technique yet it has limitations especially dense pericholecystic adhesions where the surgeon requires larger field of view for optimal dissection of gall bladder bed and for optimal control of bleeding. Though ultrasonography has been in wide use for preoperative evaluation of gall bladder stone disease yet very few studies have been conducted to evaluate its role in predicting pericholecystic adhesions responsible for difficult laparoscopic cholecystectomy. Prior knowledge of dense pericholecystic adhesions may help the surgeon in opting for open over laparoscopic cholecystectomy. Methods: Out of 70 patients with gall bladder stone disease that were enrolled in the study, complete data could be obtained in only 55 patients. All patients included in the study underwent ultrasonography of abdomen in fasting state and findings were recorded including pericholecystic adhesions & visualisation of Calot's triangle. The ultrasonographic findings were compared with that of the operative findings. Results: Our study revealed that ultrasonography has more than 70% sensitivity, more than 80% specificity and more than 76% accuracy in predicting pericholecystic adhesions which is the major cause of conversion from laparoscopic to open cholecystectomy. Conclusions: Ultrasonography can serve as an inexpensive imaging tool for predicting difficult laparoscopic cholecystectomy in patients with gall bladder stone disease by demonstrating signs of pericholecystic adhesions and nonvisualisation of normal-appearing Calot's triangle.

Ultrasound Changes of Postoperative Adhesion Types Over Time in Children

“…Their study revealed that ultrasonography has more than 70% sensitivity, more than 80% specificity, and more than 76% accuracy in predicting pericholecystic adhesions which is the major cause of conversion from laparoscopic to open cholecystectomy. 24…”

“…26 accuracy in predicting pericholecystic adhesions which is the major cause of conversion from laparoscopic to open cholecystectomy. 24 Only one study was conducted in children population that was conducted by Tan et al They assessed visceral sliding as a marker of visceroparietal adhesion. Their reported sensitivity and specificity in predicting adhesions were 75 and 80%, respectively.…”