Role of gallbladder wall thickness in predicting laparoscopic operability prior to cholecystectomy: a retrospective analysis
DOI:
https://doi.org/10.18203/2349-2902.isj20181603Keywords:
Laparoscopic cholecystectomy, Ultrasound gall bladder wall thicknessAbstract
Background: Laparoscopic cholecystectomy is the gold standard procedure for cholecystitis. There are variable rates of conversion of laparoscopic cholecystectomy to open cholecystectomy. Various studies have highlighted gall bladder wall thickness of > 3mm as an independent risk factor for conversion. The purpose of our study is to predict the feasibility of cholecystectomy laparoscopically bases on the pre-operative ultrasound guided measurement of gall bladder wall thickness.
Methods: It is a retrospective study conducted in the Department of Surgery, Himalayan Institute of Medical Sciences (HIMS) from June 2016 to September 2017. Patient’s pre-operative complete haemogram, liver function tests were also analyzed. Gallbladder wall thickness was estimated by using the maximal obtainable measurement at the fundus. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter.
Results: A total of 192 patients were included in this study. Most of the patients were of the age group between 30-40 years, with average age of 37 years and 70% of the patients were females. Out of 192, 176 patients underwent laparoscopic cholecystectomy and 16 patients required conversion to open surgery. Ninety patients (46.8%) had cholecystectomy for acute cholecystitis and one hundred two patients (53.15%) had cholecystectomy for chronic cholecystitis. The gallbladder wall was found to be greater than 3 mm in 23 patients (25.5%) with acute calculous cholecystitis and greater than 3 mm in 25 patients (24.5%) with chronic calculous cholecystitis. Forty-eight patients, out of a total of 192, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 16 of these patients (33.3%) required conversion to an open cholecystectomy.
Conclusions: Gall bladder wall thickness bases on ultrasound is a good predictor for difficult cholecystectomy and conversion to open surgery.
References
Keulemans YC, Venneman NG, Gouma DJ. New strategies for the treatment of gallstone disease. Scand J Gastroenterol. 2002;236:87-90.
Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane hepato-biliary group reviews. Cochrane Database Syst Rev. 2010;20(1):CD008318.
Lo CM, Fan S, Liu Cl, Lai E, Wong J. Early decision for conversion of Laparoscopic to open cholecystectomy for treatment of acute cholecystitis. Am J Surg. 1997;173(6):513-7.
Saleh M, Salammah A. Outcome of Laparoscopic cholecystectomy in acute cholecystitis J Coll Physicians Surg Pak. 2005;17(7):400-3.
Handler SJ. Ultrasound of gallbladder wall thickening and its relation to cholecystitis Am J Roentgenol. 1979;132(4):581-5.
Dinkel HP, Kraus S, Heimbucher J. Sonography for selecting candidates for laparoscopic cholecystectomy: a prospective study. Am J Roentgenol. 2000;174:1433.
Leander P, Ekberg O, Almqvist P. Radiology in laparoscopic cholecystectomy. A retrospective study. Acta Radiol. 1994;35:437-41.
Cuschieri A. Laparoscopic cholecystectomy. J R Coll Surg Edinb. 1999 Jun;44(3):187-92.
Gupta N, Ranjan G, Arora M, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013;11(9):1002-6.
Chen RC, Liu MH, Tu HY, Chen WT, Wang CS, Chiang LC, et al. The value of ultrasound measurement of gallbladder wall thickness in predicting laparoscopic operability prior to cholecystectomy. Clin Radiol. 1995;50:570‑2.
Grace P, Quereshi A, Darzi A, McEntee G, Leahy A, Osborne H, et al. Laparoscopic cholecystectomy: A hundred consecutive cases. Ir Med J. 1991;84:12‑4.
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, et al. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991;161:385‑7.
Dubois F, Berthelot G, Levard H. Laparoscopic cholecystectomy: Historic perspective and personal experience. Surg Laparosc Endosc. 1991;1:52‑7.
Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS. 2002;6:59‑63.
Engel JM, Deitch EA, Sikkema W. Gallbladder wall thickness: sonographic accuracy and relation to disease. AJR. 1980;134:907-9.
Jantsch H, Lechner G, Fezoulidis I, Frank W, Pichler W, Urbanek A, et al. Sonography of acute cholecystitis: Report on 58 cases with correlation to pathomorphological histological findings. Fortschr Geb Röntgen X-Ray Nuclear Med. 1987;147:171-6.
Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167:35-41
Corr P, Tate JJ, Lau WY, Dawson JW, Li AK. Preoperative ultrasound to predict technical difficulties and complications of laparoscopic cholecystectomy. Am J Surg. 1994;168:54-6.
