Gall Bladder Wall Thickness as a Predictor for Laparoscopic Cholecystectomy Difficulties in Gadarif, Eastern Sudan

Abstract

Background: Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Multiple studies have identified factors that are predictive of surgical difficulties including preoperative ultra-sonographic findings.
 Objective: To determine the effectiveness of sonographic measurement of gall bladder wall thickness as a predictive factor for laparoscopic cholecystectomy difficulties in Gadarif Teaching Hospital, Sudan.
 Patients and methods: This are a prospective, observational, analytical cross-sectional hospital-based study in which all patients who underwent laparoscopic cholecystectomy for gall stones disease and had a pre-operative sonographic measurement for GBWT in GTH in the year 2019 were included.
 Results: 110 cases were studied. The male to female ratio was 0.2: 1, the mean age was 35±3.8 years. Past history of the acute attack reported in 54 (48.2%) of the patients, history of ERCP was reported in 2 (1.8%) and the majority of patients 71 (64.5%) has no associated medical condition. Abdominal examination was normal in 69 (62.7%) of the patients, 35 (31.8%) patients showed positive Murphy's sign or other signs. Gall bladder thickening, as a predictor of difficulty, was normal of ≤ 3 mm in 69 (62.7%), mild (4-5 mm) in 34 (30.9%), moderate (6-7 mm) in 5 (4.5%), and severe > 7 in 2 (1.8%) of the patients. A significant association was found between GBWT and: duration of symptoms, the number of attacks, operative time and hospital stay, postoperative complication, and conversion to open cholecystectomy. Operative time was found to be associated with the experience of the operator (P-value < 0.05).
 Conclusion: Pre-operative sonographic increasing gall bladder wall thickness is associated with difficult laparoscopic cholecystectomy in terms of postoperative complications, prolonged operative time, and conversion to open cholecystectomy even in expert hands.