A CORRELATIVE STUDY BETWEEN PREOPERATIVE USG FINDINGS AND DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Background: Laparoscopic cholecystectomy (LC) is the gold standard for
gallbladder pathology and has various advantages over open cholecystectomy (OC),
such as less postoperative pain and faster recovery. This research aims to determine
whether preoperative USG findings can be used to predict conversion from LC to
OC. Methods: This prospective observational research was done between December
2023 and November 2024 at Fakhruddin Ali Ahmed Medical College and Hospital,
Barpeta, Assam. All 200 cholelithiasis-diagnosed patients were enrolled, fulfilling
the indications of laparoscopy. All patients underwent preoperative USG to
determine the status of gallbladder (contracted, normal, distended, and
overdistended), wall thickness in mm, stone size in cm, number of stones, and
presence of pericholecystic fluid. Results: Amongst 200 patients, 65% were women
and 35% were men with a mean age of 42.5 years. 70% of the patients had
overdistended or normally distended gallbladders, and 30% had contracted
gallbladders. Wall thickness greater than 3 mm was present in 48.5% of the patients,
and 49% had pericholecystic fluid. The size of the stones greater than 1 cm was
present in 45% of the cases. Among the 200 patients, 90% were successfully
operated upon using laparoscopic cholecystectomy, while 10% required conversion
to open surgery. The preoperative USG findings, such as gallbladder wall thickening,
large gallstone, and pericholecystic fluid, were strongly predictive of conversion to
OC. Multivariate analysis showed these ultrasound factors, along with gallbladder
status, as independent predictors of conversion (p<0.05). Conclusion: Preoperative
ultrasonography provides valuable information on predictors of conversion from
laparoscopic to open cholecystectomy. From this study, incorporation of preoperative
USG findings into the intraoperative plan has been suggested as a means of
identifying high-risk patients, reducing patient complications, and minimizing
complications due to open surgery conversion.