Difficult Laparoscopic Cholecystectomy: Role of Ultrasonography

Introduction: Laparoscopic cholecystectomy (LC) is now the standard procedure for the treatment of symptomatic gallbladder stones. Although laparoscopic cholecystectomy has numerous advantages it has increased risk of injury to common bile duct, duodenum, bowel, iliac vessels, high conversion rate in acute cholecystitis and difficulty in management of simultaneous CBD stones. Ultrasonography is the most common non-invasive, safe, and highly accurate screening test for cholecystitis and cholelithiasis. It can help the surgeons to get an idea of potential difficulty to be faced during laparoscopic surgery in that particular patient. The present study was thus conducted with the aim of evaluation of pre-operative ultrasound findings in predicting difficulties in laparoscopic cholecystectomy for cholelithiasis Materials & Methods: A hospital based observational study was conducted at a tertiary care centre from Oct 2013 to Oct 2015. A total of 100 consecutive patients of calculous cholecystitis undergoing laparoscopic cholecystectomy were included in the study. All the patients underwent pre-op USG evaluation for possible difficulty during the laparoscopic procedure. Based on various sonographic findings, the pre-op assessment was labelled as easy or difficult. The results were compared with the observeddifficulty during Laparoscopic cholecystectomy.Statistical analysis was done using SPSS ver. 21. Results: The predicted difficulty for laparoscopic cholecystectomy was seen in 35% subjects, out of which 3 cases actually had difficult laparoscopic procedure (sensitivity & specificity – 100% & 67%) while conversion to open procedure was required in one patient (sensitivity & specificity – 100% & 65.7%). Conclusion: By careful preoperative USG by an experienced radiologist, difficult laparoscopic cholecystectomy can be predicted and that may help in proper pre-operative planning and counseling to reduce overall complications and morbidity. Recommendation: Preoperative ultrasonography should be used as a screening procedure for prediction of difficulty in laparoscopic cholecystectomy. It can help surgeons to get an idea of the potential difficulty to be faced in that particular patient.