Author(s): Dr. Prasanna Panneerselvam, Dr. S Madhivannan and Dr. Ravichandran

Abstract: Background: Cholelithiasis is a prevalent alimentary tract disorder traditionally treated with open cholecystectomy. Advances in technology have favoured laparoscopic cholecystectomy (LC) as a minimally invasive alternative with fewer complications. Preoperative ultrasonography (USG) is crucial in diagnosing cholecystitis and cholelithiasis, and it offers significant insights into potential intraoperative challenges.Aim: To evaluate the correlation between preoperative ultrasonographic findings and intraoperative difficulties in laparoscopic cholecystectomy, and assess the need for conversion to open cholecystectomy.Materials and Methods: This prospective analytical study was conducted from September 2022 to July 2024 at AVMCH’s Department of General Surgery. Fifty-seven patients planned for elective LC were included, based on specific inclusion criteria and excluding those with extensive surgical history or severe bile duct conditions. USG parameters such as gallbladder wall thickness, pericholecystic fluid, gallbladder size, and gallstone characteristics were analysed against intraoperative factors like surgery duration, dissection times, and complications.Results: The mean patient age was 48.5 years, with a predominance of female patients (77.2%). Ultrasound indicated normal gallbladder size in 89.5%, multiple stones in 84.2%, and stones >1 cm in 21.1%. Intraoperatively, a duration >120 minutes correlated significantly with aberrant anatomy, a common bile duct (CBD) size >8 mm, and gallbladder wall thickness >4 mm. Dissection of Calot's triangle and gallbladder bed lasting >20 minutes was associated with gallbladder wall thickness >4 mm and multiple stones. Complications such as gallbladder tear and bile spillage (14%) were frequent in patients with a gallbladder wall thickness >4 mm and stones impacted at the gallbladder neck. Conversion to open cholecystectomy was necessary in 3.5% of cases.Conclusion: Preoperative USG effectively predicts intraoperative difficulties in laparoscopic cholecystectomy. Indicators like gallbladder wall thickness, CBD size, and the presence of multiple or impacted stones provide critical information for surgical planning, potentially reducing complications and improving patient outcomes.

DOI: 10.22271/27081494.2024.v6.i2a.103

Pages: 06-11 | Views: 286 | Downloads: 78

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