Original Research Article
Year: 2020 | Month: April | Volume: 7 | Issue: 4 | Pages: 223-231
Ultrasonographic Predictors of Difficult Laparoscopic Cholecystectomy
Rajeev Kumar Singh1, Prateek Shakya2, Benot Sutnga3
1Associate Professor, 2Assistant Professor, 3Post Graduate resident,
General Surgery, Sushila Tiwari Government Hospital, Haldwani, Uttarakhand
Corresponding Author: Benot Sutnga
ABSTRACT
Aims: Ultrasonographic predictors of difficult laparoscopic cholecystectomy.
Materials And Methods: A prospective longitudinal study was conducted included 250 patients who underwent elective laparoscopic cholecystectomy for uncomplicated gallstone disease. The study was conducted at one surgical unit in Department of Surgery in collaboration with Department of Radio-diagnosis.
Results: In this study out of 250 patients, 158(63.2%) patients have only gallstones and 92(36.8%) patients have ultrasound findings of gallstones associated with other findings in gallbladder. Out of these 93 patients, 29.3% patients have gallbladder wall thickness more than 4mm; 43.5% patients have gallbladder stone impacted at the neck; 18.5% patients have contracted gallbladder; 8.7% patients have common bile duct diameter more than 6mm. Gall bladder wall thickness more than 4mm leads to difficult laparoscopic cholecystectomy in 25.4% cases. 40 patients have contracted gallbladder and 46% of them had undergone difficult laparoscopic cholecystectomy. In the present study, 8 patients had common bile duct dilated more than 6mm and all of them had to undergo difficult laparoscopic cholecystectomy. Time taken from insertion of trocar to gallbladder extraction is more than 90mins in majority of cases (52.2% vs 12.1%) with ultrasound findings of gallstones associated with other findings than the cases with ultrasound findings of gallstones only. Intra operative complications which led to difficult laparoscopic cholecystectomy; majority of cases (56%) had dense adhesions at calots triangle and surrounding structure followed by tear of cystic artery during dissection which accounted for 24.4% of patients.
Conclusion: Ultrasonographic findings of gallbladder wall thickness more than 4mm, stone impacted at the neck of gallbladder, contracted gallbladder, common bile duct diameter more than 6mm are found to be significant predictors of difficult laparoscopic cholecystectomy in our study.
Keywords: Laparoscopic cholecystectomy, difficult cholecystectomy, Calot’s triangle, uncomplicated gallstone disease
[PDF Full Text]