DOI: 10.36347/sjams.2017.v05i11.088

Pages: 4757-4760

Ultrasound (USG) abdomen is an important diagnostic modality in the diagnosis of gallstone disease. The present study aims to determine reliable pre-operative ultrasonographic parameters which may predict the degree of difficulty in performing laparosccopic cholecystectomy. This study presents analysis of 100 consecutive cases of cholelithiasis undergoing elective cholecystectomy at Department of Surgery, G.R. Medical College & J.A. Group of Hospitals, Gwalior (M.P) during the period of one year from November 2012 to November 2013 studied in a prospective manner. The patients were fasting overnight for the maximal distention of the gallbladder. The pre-operative ultrasonography was done with 3.5 Mhz probe on Diasonics spectra colour Doppler ultrasound on B mode, Gray-scale, real time scan. The mean gallbladder wall thickness in the study was 2.9 mm (maximum - 5.6 mm and minimum – 1.8 mm). Eighteen (18%) patients with gallbladder wall thickness more than 4 mm. There were eighteen (18%) patients with contracted gallbladder, and the remaining 82 patients had either gallbladder of normal volume that is approx. 50 ml or more. Six (6 %) patients with gallstone impacted at the neck of gallbladder or Hartman's pouch. Only 2 patients had common bile duct diameter greater than 6 mm. Out of total 100 cases, nine (9%) cases were converted to open procedure. Significant correlation was found between the independent ultrasonographic parameters (that is gallbladder wall thickness, contracted gallbladder, stone impaction at the neck of gallbladder) with the difficult laparoscopic cholecystectomy and their subsequent conversion to open cholecystectomy. Pre-operative ultrasonography is a good predictor of difficulty in laparoscopic cholecystectomy in majority of the cases and should be used, as a screening procedure.