Assessment and Correlation of Technical Difficulties and Conversion to Open Procedure During Laparoscopic Cholecystectomy by Preoperative Ultrasonography

Laparoscopic cholecystectomy is now the gold standard for the treatment of gall stone disease and ultrasonography is the most common imaging study performed for biliary tract disease. The various pre-operative parameters in literature for predicting difficult laparoscopic cholecystectomy are reported. The present study was conducted to look for some predictive factors on ultrasonography of gallbladder that can give surgeon some idea about the potential difficulty and complications that may be encountered during the course of laparoscopic cholecystectomy. This study was conducted on patients undergoing laparoscopic cholecystectomy in Department of General and Laparoscopic Surgery at Dr. S. N. Medical College Jodhpur, India. In this study we have included 146 patients of all age groups and both sex, in which four ultrasonic parameters for predicting difficult laparoscopic cholecystectomy were analyzed. All patients included in the study were undergone detail history and clinical examination. Pre-operative ultrasound was done for all patients .The selected patients were then told about the procedure and written informed consent was taken. Patients were also informed about the conversion to open cholecystectomy. In our study a strong statistical correlation was found between pre-operative ultrasound and difficulty in the laparoscopic cholecystectomy. The study shows that preoperative ultrasound can predict operative difficulty for laparoscopic cholecystectomy to a good extent. Pre operative ultrasonography can also aid in recognition of cases where an open cholecystectomy should be considered and the patient counselled preoperatively.