Citation Information :
Arone S, KJ R, Venkatasubramanian R, Muralidharan M, Chordia D. Role of Preoperative Ultrasonography Findings in Predicting Difficult Laparoscopic Cholecystectomy. World J Lap Surg 2022; 15 (3):229-234.
Aim: Most of the complications in a laparoscopic cholecystectomy are due to the difficulties faced during the surgery. In this research, the attempt was made to determine the factors that can predict a difficult laparoscopic cholecystectomy preoperatively based on ultrasound findings.
Materials and methods: One hundred patients who are satisfied with our inclusion criteria were included in our study. Preoperative ultrasonography (USG) findings like thickness and size of the gallbladder (GB) wall, the diameter of the common bile duct (CBD), GB stone size and numbers, and the existence of fluid collection around the GB were given a grade of 1 or 0 based on findings being affirmative or dissent. The sums of the grade were taken and were interrelated with the difficult laparoscopic cholecystectomy. Intraoperative findings, namely, injury and damages made to the bile duct, CBD or artery, the existence of thick adhesions on the GB sides, region of the Calot's being frozen, ripped up GB and spillage of bile and stones, unusual and atypical anatomy, bleeding that hampers and obstructs the visual field, and time taken of 60–120 minutes were considered as difficult laparoscopic cholecystectomy.
Results: Four preoperative findings, namely, the thickness of GB, GB stone impacted at the neck, GB stone size, and the existence of fluid collection around the GB had statistical significance in anticipating a difficult laparoscopic cholecystectomy. An elevated preoperative ultrasonography score had shown higher chances of a difficult laparoscopic cholecystectomy.
Conclusion: Preoperative ultrasonography findings have a role in predicting a difficult laparoscopic cholecystectomy.
Clinical significance: Laparoscopic cholecystectomy will be useful to have some authentic factors (USG findings) to prognosticate difficulty, conversion, or complications in laparoscopic cholecystectomy.
Csikesz NG, Singla A, Murphy MM, et al. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci 2010;55(8):2398–2405. DOI: 10.1007/s10620-009-1035-6.
Schirmer BD, Edge SB, Dix J, et al. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg 1991;213(6):665–676. DOI: 10.1097/00000658-199106000-00018.
Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy. The new “gold standard”? Arch Surg 1992;127(8):917–921. DOI: 10.1001/archsurg.1992.01420080051008.
Zucker KA, Bailey RW, Flowers J. Laparoscopic management of acute and chronic cholecystitis. Surg Clin North Am 1992;72(5):1045–1067. DOI: 10.1016/s0039-6109(16)45831-7.
Persson G, Strömberg J, Svennblad B, et al. Risk of bleeding associated with use of systemic thromboembolic prophylaxis during laparoscopic cholecystectomy. Br J Surg 2012;99(7):979–986. DOI: 10.1002/bjs.8786.
Chindarkar H, Dumbre R, Fernandes A, et al. Study of correlation between pre-operative ultrasonographic findings and difficult laparoscopic cholecystectomy. Int Surg J 2018;5(7):2605–2611. DOI: 10.18203/2349-2902.isj20182782.
Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: A scoring method. Indian J Surg 2009;71(4):198–201. DOI: 10.1007/s12262-009-0055-y.
Rosner B. Fundamentals of Biostatistics, 5th edition. Belmont: Duxbury Press, 2000. ISBN: 10 0538733497.
Riffenburgh RH, Cummins KM. A simple and general change point identifier. Stat Med 2006;25(6):1067–1077. DOI: 10.1002/sim.2237.
Rao PS, Richard J. An Introduction to Biostatistics: A Manual for Students in Health Sciences. India: Prentice–Hall, 1996. ISBN: 10-812031008X.
Daradkeh SS, Suwan Z, Abu-Khalaf M. Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy. World J Surg 1998;22(1):75–77. DOI: 10.1007/s002689900352.
Lal P, Agarwal PN, Malik VK, et al. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. J Soc Laparoendosc Surg 2002;6(1):59–63. PMID: 12002299.
Carmody E, Arenson AM, Hanna S. Failed or difficult laparoscopic cholecystectomy: Can preoperative ultrasonography identify potential problems? J Clin Ultrasound 1994;22(6):391–396. DOI: 10.1002/jcu.1870220606.
Kreimer F, Cunha DJD, Ferreira CCG, et al. Comparative analysis of preoperative ultrasonography reports with intraoperative surgical findings in cholelithiasis. Arq Bras Cir Dig 2016;29(1):26–29. DOI: 10.1590/0102-6720201600010007.
Corr P, Tate JJ, Lau WY, et al. Preoperative ultrasound to predict technical difficulties and complications of laparoscopic cholecystectomy. Am J Surg 1994;168(1):54–56. DOI: 10.1016/s0002-9610(05)80071-6.
Dinkel HP, Kraus S, Heimbucher J, et al. Sonography for selecting candidates for laparoscopic cholecystectomy: A prospective study. AJR Am J Roentgenol 2000;174(5):1433–1439. DOI: 10.2214/ajr.174.5.1741433.
Santambrogio R, Montorsi M, Bianchi P, et al. Technical difficulties and complications during laparoscopic cholecystectomy: Predictive use of preoperative ultrasonography. World J Surg 1996;20(8):978–981. DOI: 10.1007/s002689900147.
Akhter T, Lodhi JK, Malik A, et al. Ultrasound scoring system for pre-operative anticipation of difficult laparoscopic cholecystectomy. J Rawalpindi Med Coll 2018;22(3):240–243. Available from: https://www.journalrmc.com/index.php/JRMC/article/view/925.
Nidoni R, Udachan TV, Sasnur P, et al. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. J Clin Diagn Res 2015;9(12):PC09-12. DOI: 10.7860/JCDR/2015/15593.6929.
Lein HH, Huang CS. Male gender: Risk factor for severe symptomatic cholelithiasis. World J Surg 2002;26(5):598–601. DOI: 10.1007/s00268-001-0275-1.
Kama NA, Kologlu M, Doganay M, et al. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg 2001;181(6):520–525. DOI: 10.1016/s0002-9610(01)00633-x.
Sugrue M, Sahebally SM, Ansaloni L, et al. Grading operative findings at laparoscopic cholecystectomy: A new scoring system. World J Emerg Surg 2015;10:14. DOI: 10.1186/s13017-015-0005-x.
Soltes M, Radoňak J. A risk score to predict the difficulty of elective laparoscopic cholecystectomy. Wideochir Inne Tech Maloinwazyjne 2014;9(4):608–612. DOI: 10.5114/wiitm.2014.47642.
Gupta N, Ranjan G, Arora MP, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg 2013;11(9):1002–1006. DOI: 10.1016/j.ijsu.2013.05.037.
Vivek MA, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg 2014;10(2):62–67. DOI: 10.4103/0972-9941.129947.
Fried GM, Barkun JS, Sigman HH, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 1994;167(1):35–39. DOI: 10.1016/0002-9610(94)90051-5.