Association of Gallbladder Wall Thickness on Preoperative Ultrasonography with Intraoperative Difficulty in Laparoscopic Cholecystectomy

Background: Gallstone disease is common in adult population. Untreated, it can cause acute cholecystitis, cholangitis, obstructive jaundice and acute pancreatitis. Laparoscopic cholecystectomy is the procedure of choice for management of symptomatic gallstones for its minimal invasiveness, less pain and early recovery. However, it at times becomes difficult requiring conversion to open cholecystectomy. Risk factors associated with difficult surgery are elderly, males, attacks of acute cholecystitis, obesity, abdominal scar and ultrasonographic findings i.e. thickened gallbladder wall, pericholecystic collection, impacted stone etc. It is difficult to predict easy or difficult surgery preoperatively, although an important aspect of planning laparoscopic surgery to determine need for longer hospitalization or more intensive postoperative care. This observational study was undertaken to estimate the association of gallbladder wall thickness on preoperative ultrasonography with intraoperative difficulty in laparoscopic cholecystectomy. Methods: All patients of either gender undergoing elective laparoscopic cholecystectomy at tertiary care teaching hospital were included and evaluated by preoperative ultrasonography. Intra-operative findings were noted based on the criteria defined in the study. Results: A hospital based prospective, observational study was conducted and 200 patients evaluated for association of gallbladder wall thickness on preoperative ultrasonography with intraoperative ease/difficulty in laparoscopic cholecystectomy. 85 (42.5%) had easy Laparoscopic Cholecystectomy and 115 (57.5%) had difficult Laparoscopic Cholecystectomy. Association with pericholecystic collection and stone impaction was also studied.