Laparoscopic cholecystectomy in wall echo complex gall stone disease: a study
DOI:
https://doi.org/10.18203/2349-2902.isj20171133Keywords:
Cholelithiasis, Laparoscopic cholecystectomy, WES, Wall echo complexAbstract
Background: There are so many subtitles for difficult laproscopic cholecystectomy. Stone in the neck of gall bladder constitutes one of the entities. Wall echo complex is an ultrasound terminology used for cholelithiasis. It has three layers, first the pericholecystic fat between gallbladder and liver. Second layer consists of gall bladder wall. The third layer consists of echogenic stone itself. Wall echo complex is one of the entities which constitute difficult laproscopic cholecystectomy. Wall echo complex in the neck of the gall bladder is particularly difficult gall bladder where the conversion rates are high.
Methods: The study was conducted in Department of Surgery. Standard four port cholecystectomy was done in 50 patients. Wall echo complex in all these patients was reported by ultrasonologist. Difficulties in operating wall echo complex cholelithiasis consisted of dissection of neck of gall bladder due to adhesions and a sleeve of fat covering the calot’s triangle. The difficulty of wall echo cholelithiasis was managed by opening the neck of gall bladder and evacuating the stones into a separate latex bag. By this procedure the difficult wall echo cholelithiasis was managed in all cases. Ligaclips were used for ligation of cystic duct, cystic artery and pericholecystic veins.
Results: The evacuation of stones from the neck of gall bladder led to an easy cholecystectomy in 46 patients while the four patients had conversion to open cholecystectomy.
Conclusions: Wall echo complex although an ultrasonologists entity but is a difficult gall bladder for laproscopic cholecystectomy.
References
Nachani J, Supe A. Preoperative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonic parameters. Ind J Gastroenterology. 2005;24:16-8.
Jansen S, Caplehom J. Preoperative ultrasound to predict conversions in laparoscopic cholecystectomy. Surg Laparosc Endosc. 1997;7:121-3.
Rizvi SA, Ali SA, Akhtar S, Faridi S, Ahmed M. Forecast of difficult laparoscopic cholecystectomy by sonography: an added advantage. Biomedical Research. 2012;23(3):425-9.
Donald FR, Cooperberg PL, Cohen MM. The WES triad - a specific sonographic sign of gall stone in the contracted gall bladder. Gastrointest Radio. 1981;6(1):39-41.
Raptopoulos V, Orsi C, Smith E, Reuter K, Moss l, Kleinman P. Dyanamic cholecystography of the contracted gall bladder: the double arc shadow sign. Am Roentgenol. 1982;138(20):275-8.
Laing FC, Gooding GA, Herzog KA. Gallstones preventing ultrasonographic visualization of the gallbladder. Gastointest Radiol. 1977;1(4):301-3.
George N, Dawkins A, Santis D. The wall-echo-shadow (WES) sign. Abdom Imaging. 2015;40(7):2903.
Rybicki F. The WES sign. Radiology. 2000;214:881-2.
Datta A, Garg N, Lema PC. The significance of the wall echo shadow triad on ultrasonography: a case series. Crit Ultrasound J. 2010;2(3):107-8.
Desilva M, Ferriando D. Anatomy of the calot’s triangle and its relevance to laparoscopic cholecystectomy. Ceylon Med J. 2001;46(1):33-4.
Singh K, Ohri L. Anatomical landmarks: their usefulness in safe laparoscopic cholecystectomy. Surg Endosc. 2006;20:1754-8.
Nagral S. Anatomy relevant to cholecystectomy. J Minim Access Surg. 2005;1(2):53-8.
Singla A, Gupta S, Garg N, Bharti P, Chun P. The significance of the wall echo shadow triad on ultrasonography in emergency department patients. Annals Emergency Med. 2009;54(3):102.
