Gall Bladder Wall Thickness: Sonographic Accuracy and Laparoscopic Cholecystectomy Conversion Rate, Evaluated by Histopathology

Abstract

Background: Preoperative prediction of a difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for intraoperative risk and the risk of conversion to open Cholecystectomy. Aim of study: Evaluation the impact of gall bladder wall thickness, on the outcome of laparoscopic cholecystectomy and conversion rate to open cholecystectomy assessed by sonography preoperative and postoperative measurement of gall bladder wall thickness by histopathology. Patients and Methods: A prospective study conducted in the surgical unit, Department of surgery, Baghdad Teaching Hospital between November 2010 and November 2011. Abdominal Sonography performed in 110 consecutive patients before laparoscopic cholecystectomy. The surgeon re-verified sonographic finding in operative room, and postoperatively, the gall bladder specimens were sent for histopathological measurement of wall thickness. Results: Out of 110 patients with cholecystolithiasis on sonography, we encountered easy laparoscopic cholecystectomy in 80 patients (72.7%), difficult laparoscopic cholecystectomy in 24 (21.8%) and the procedure was converted to open cholecystectomy in six patients (5.5%). The difference between Sonographic and histological measurement was within 1 mm in 102 patients (92.7%), and the other 8 patients was with 1.5 mm (7.3%) with sensitivity of (100%), specificity of (83.3%) and accuracy of (97%). Conclusion: An accurate preoperative diagnostic sonography is mandatory for planned laparoscopic gall bladder surgery to provide information for the selection of the most appropriate approach and avoid intraoperative difficulties and surprises. On sonography gall bladder wall thickening is the most sensitive indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.