Gallbladder Wall Thickening Research Articles

Pre-operative Predictive Factors for Difficult Laparoscopic Cholecystectomy at Tertiary Care Centre

INTRODUCTION Gallstones are present in 10 to 15% of general population and asymptomatic in more than 80% cases. Laparoscopic cholecystectomy is a gold standard treatment for cholelithiasis. The rate of conversion from laparoscopic cholecystectomy to open is about 1-13%. Predicting the difficulty of laparoscopic cholecystectomy is essential to optimize patient outcomes. The levels of difficulties during laparoscopic cholecystectomy can be predicated based on certain preoperative clinical, laboratory or radiological parameters. The main aim of the study was to find out the pre-operative predictive factors for difficult laparoscopic cholecystectomy at a tertiary care centre. MATERIAL AND METHODS This was an observational cross-sectional study that included sixty nine patients who underwent elective laparoscopic cholecys- tectomy in UCMS. Preoperative predictive parameters such as age, gender, BMI, previous abdominal surgery, gallbladder condition, and ultrasound findings were assessed. A scoring system developed by Randhawa and Pujahari was used to predict difficulty in laparoscopic cholecystectomy, and intraoperative criteria were used to categorize cases as easy or difficult. RESULTS History of acute cholecystitis (p=0.026), previous abdominal scar (p=0.024), thick gallbladder wall (p=0.012), impacted stone (p=0.057), pericholecystic fluid collection (p<0.001) and increased BMI were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity for easy - difficult cut off of the scoring method were 75.6% and 67.16%, respectively, with the area under the ROC curve being 0.524. CONCLUSION The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on preoperative scoring system.

Preoperative prediction model for non-neoplastic and benign neoplastic polyps of the gallbladder

BackgroundGallbladder adenoma represents a precancerous lesion of gallbladder cancer. However, distinguishing it from cholesteryl polyps of the gallbladder before surgery is challenging. Thus, we aimed to comprehensively explore various risk factors contributing to the formation of gallbladder adenoma to facilitate an informed diagnosis and treatment by clinicians. MethodsWe conducted a retrospective analysis of patients who had undergone cholecystectomy at the Affiliated Hospital of Qingdao University between January 2015 and December 2022. Following postoperative pathological examination, patients were categorized into cholesterol polyp and adenoma groups. We analyzed their baseline characteristics, ultrasound imaging variables, and biochemical data using logistic, lasso, and stepwise regression. Subsequently, we constructed a preoperative prediction model based on the independent risk factors. ResultsRegression analysis of 520 gallbladder polyps and 288 gallbladder adenomas in the model group revealed that age, gallbladder wall thickness, polyp size, echogenicity, pedunculation, and adenosine deaminase (ADA) levels were independent predictors of gallbladder adenoma, all with P < 0.05. Using these indicators, we established a regression equation: Logistic (P) = −5.615 + 0.018 ∗ age - 4.64 ∗ gallbladder wall thickness + 1.811 ∗ polyp size + 2.855 ∗ polyp echo + 0.97∗ pedunculation + 0.092 ∗ ADA. The resulting area under the curve (AUC) value was 0.894 (95 % CI: 0.872–0.917, P < 0.01), with a sensitivity of 89.20 %, specificity of 79.40 %, and overall accuracy of 84.41 % for adenoma detection. ConclusionAge, polyp size, gallbladder wall thickness, polyp echogenicity, pedunculation, and ADA levels emerge as independent risk factors for gallbladder adenoma.

Prediction of difficult laparoscopic cholecystectomy on the basis of preoperative ultrasonography assessment

Background: Laparoscopic cholecystectomy (LC) is widely used for cholecystolithiasis. Abdominal ultrasonography (USG) is the investigation of choice for diagnosis of gall stone and often done before cholecystectomy. It also helps to predict possible complications during peri-operative period. Till now, there is no established definition of difficult LC. Method: Patients diagnosed as cholecystolithiasis confirmed by USG were studied. Nine parameters of abdominal USG had been assessed. Each parameter was divided into two groups, group A and group B based on finding of USG. Total number of USG finding of each group was calculated. Each surgery was assessed and categorise as easy or difficult and co related with total number of USG finding of each group. Results: For difficult LC-group B USG criteria ≥4 with group A USG criterion ≤5 having sensitivity 84.09%, specificity 80.43% and diagnostic accuracy 82.22%. For easy LC-group A USG criterion ≥6 with group B USG criteria ≤3 having sensitivity 80.43%, specificity 84.09% and diagnostic accuracy 82.22%. For easy LC, the mean post-operative stay was 1.57 days and for difficult LC, the mean post operative stay was 2.52 days. Conclusions: Preoperative USG assessment is a good predictor of difficult LC. Thick-walled gall bladder (GB), presence of pericholecystic fluid collection, impacted stone at neck or proximal to neck of GB and contracted GB are good predictors of difficult LC. Gender is not an independent risk factor for difficult LC.

A case report of Liver Cirrhosis on an Alcoholic patient with abdominal distension

Alcoholic liver disease is a condition characterized by the impairment of liver function as a result of excessive alcohol consumption. The present case is of a male patient age of 70 year abdominal distention. Patient was found abnormalities with LFT, CBC, US Abdomen coarse texture, Gall Bladder wall thickening, Spleen with enlarged mass. Patient was assessed suffering from alcoholic liver cirrhosis. After the successful treatment patient was improved the condition and discharged.

Evaluation of gallbladder contractility and Doppler findings in patients with irritable bowel syndrome; a case-control study

Background Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder causing abdominal pain, altered bowel habits and bloating without structural issues. Gallbladder dysfunction may be linked to IBS due to disrupted cholecystokinin release. This study aims to assess gallbladder function and related hemodynamic parameters using Doppler ultrasound in IBS before and after meals. Method In this case-control study, we investigated gallbladder function differences between constipation-predominant IBS (C-IBS) patients and healthy volunteers. Participants underwent ultrasonography to measure gallbladder parameters before and after consuming a predefined meal. Gallbladder volume, wall thickness and resistance index (RI) of cystic and superior mesenteric arteries (SMA) were assessed. Student t-test and paired t-test were used to compare case and control groups and pre- and post-meal data, respectively. Results A total of 34 people (18 C-IBS and 16 healthy control) were included. The mean (Standard deviation) of gallbladder fasting volume was measured 24.74 (8.85) and 29.73 (9.65) cubic millimeter for case and controls, respectively. Postprandial volume was 11.34 (5.66) and 16.9 (6.16) cubic millimeter for case and controls respectively. We observed a statistically significant difference in emptying fractions (EF) between groups (p value = 0.009). IBS patients had a smaller fasting SMA RI (p value = 0.016) but the fraction of change after meal was not significant (p value = 0.10). The cystic artery RI did not reach statistical significance between the fasting and post-meal values (p value = 0.067). Conclusion IBS patients have a higher emptying fraction and lower change in SMA RI compared to healthy controls. Further studies with larger sample size, inclusion of patients with different coexisting conditions and subtypes of IBS and combining colon transit study with gallbladder ejection fraction evaluation can be used to further provide more meaning to this study.

ASO Author Reflections: Surgical Middle Ground-Navigating the Intraoperatively Detected IncidentalSuspicious Gallbladder Wall Thickening: "The Parray's Approach".

ASO Author Reflections: Surgical Middle Ground-Navigating the Intraoperatively Detected IncidentalSuspicious Gallbladder Wall Thickening: "The Parray's Approach".

Primary Gallbladder B-Cell Lymphoma as a Finding in Post Cholecystectomy with Diffuse Gallbladder Wall Thickening: A Case Report

Primary Gallbladder B-Cell Lymphoma as a Finding in Post Cholecystectomy with Diffuse Gallbladder Wall Thickening: A Case Report

HPB P47 Torsion of a wandering gallbladder

Abstract Background Gallbladder torsion is an uncommon cause of acute abdomen. Despite over 500 reports published since 1898, only 10 cases of wandering gallbladder have been reported. In this anatomical variant (4-5% of the population) the gallbladder has no attachments to the liver. It is suspended only by the cystic duct and artery, which predisposes to twisting of the pedicle. Subsequent gallbladder necrosis can lead to rupture, peritonitis, sepsis and death (6%). Patients are typically elderly females, above the age of 70. A palpable gallbladder is described in 54% of cases. We report a rare case of wandering gallbladder leading to torsion. Methods An 89-year-old lady presented to emergency department with abdominal pain associated with vomiting and bowel not opened for five days. A palpable mass was evident on the right lower side of her small abdomen. Vital signs and lactate level were within normal range. Despite CRP was only moderately elevated on admission, it suddenly climbed to 504 within 24 hours. An abdominal CT scan showed a distended thick-walled gallbladder with a large stone, reported as “consistent with chronic calculous cholecystitis”. Results The patient was urgently brought to theatre for a laparoscopy where a free-floating gallbladder was found at the right lower quadrant, distended and gangrenous, rotated around its vascular axis. The surgery was converted to open due to lack of sufficient intra-abdominal space to accomplish the procedure. Her gallbladder was in the end successfully removed with no further concern and a washout of the peritoneal cavity was performed. The subhepatic drain was removed on day 1 postoperative. She recovered uneventfully and was discharged 12 days later due to social issues. Conclusions Despite rarely encountered, gallbladder torsion should be considered in the differential of patients presenting with acute abdomen, especially in case of rapid deterioration. Symptoms are nonspecific, as well as radiographic signs. A preoperative diagnosis is rarely made. If delayed, the condition may potentially become life-threatening. Surgical exploration is thus warranted and, once recognized, cholecystectomy remains the only resolutive treatment.

Flea-Borne Typhus Presenting with Acalculous Cholecystitis and Severe Anemia

Background. Flea-borne typhus (FBT), an uncommon illness in the United States, typically presents as a high continuous fever with commonly associated symptoms including headache, myalgias, and rashes on the trunk and extremities. Patients infected with FBT may also present with atypical symptoms. As such, the combination of its relatively low incidence in the United States coupled with its variability in associated symptoms poses a diagnostic challenge for clinicians; early empiric treatment with doxycycline is warranted prior to a definitive diagnosis to reduce the risk of damage to vital organs. Case Report. This case describes a 54-year-old male who presented to an emergency room in Houston, Texas, with one week of constant right upper quadrant abdominal pain and fevers up to 40°C. The patient was initially diagnosed with Grade III severe acute cholangitis after abdominal ultrasound revealed gallbladder sludge and wall thickening without ductal dilatation, but a subsequent endoscopic retrograde cholangiopancreatography was unremarkable. Following intermittent fevers and worsening anemia, the patient was started on oral doxycycline for atypical infection, and an infectious disease workup subsequently returned a positive titer for Rickettsia typhi. He experienced rapid symptomatic and clinical improvement, and the patient was discharged home with a final diagnosis of flea-borne typhus. Conclusion. Albeit uncommon, the presentation of this patient’s symptoms and final diagnosis of flea-borne typhus demonstrates the importance of (1) keeping atypical infections such as FBT in the differential diagnosis and (2) beginning empiric treatment to prevent damage to vital organs if suspicion of FBT is high.

Predictors for Gangrene and Perforation of Gallbladder Wall in Patients with Acute Cholecystitis

Summary Perforation of the gallbladder wall leads to a local perivesical abscess or progression to biliary peritonitis. The study aimed to analyse clinical, laboratory, and imaging indicators that have the strongest relationship with the presence of gangrenous cholecystitis and perforation of the wall and to design a predictive scoring system that highlights the risk of developing gangrenous cholecystitis with perforation. We performed a retrospective analysis of a total of 331 patients operated for five years (2016-2020) at the Department of Surgical Diseases” of Medical University - Pleven, with histologically verified chronic cholecystitis (120 patients; 36.4%), acute cholecystitis (100 patients; 30.1%), and destructive cholecystitis (111 patients; 33.5%). The statistical analysis identified nine main factors with the most substantial statistical significance in patients with gangrene and perforation of the gallbladder wall: age &gt;65, male gender, diabetes mellitus, cardiovascular pathology, tachycardia&gt;90 bpm, WBC&gt;14.109, the thickness of gallbladder wall &gt; 4 mm with pericholecystic fluid, ASAT and ALAT &gt; 40 UI, CRP&gt;150 ng/l. The total possible score was 11 points. The positive predictive value of the scale was 96% and identified the cases with micro-perforation and perivesical abbesses among the group with the highest total score.

Laparoscopic Cholecystectomy in Children: The Experience of Two Centers Focusing on Indications and Timing in the Era of "New Technologies".

In children, laparoscopic cholecystectomy (LC) is now considered the gold standard for gallbladder (GB) removal. In the past, hemolytic disorders associated with cholelithiasis represented the most frequent conditions requiring LC; this is being overtaken by cholelithiasis and biliary conditions in overweight or ex-premature children. This study aims to describe current indications and timing for LC in pediatric patients. Retrospective study. Data on previous medical therapy, ultrasound, pre- and intraoperative aspects, and histology were collected for patients treated in 2020-2023. In total, 45 patients were enrolled: 15 who underwent urgent surgery and 30 electives. Groups differed in terms of obesity rate, symptoms, ultrasound features, and intraoperative status. The most relevant risk factors for surgical complexity were age and pubertal stage, elevated cholestasis indexes, and gallbladder wall thickness > 3 mm at ultrasound. GB wall thickening ≥3 mm, US Murphy sign, fluid collections, and gallbladder distention on ultrasound correlated with high surgical scores. Indications for laparoscopic cholecystectomy in children seem to evolve caused by changing characteristics of the pediatric population. Patients with overweight/obesity may develop more complex GB diseases. Asymptomatic patients should be considered for surgery after observation, considering age and/or pubertal maturation when other risk factors are absent.

Percutaneous cholecystostomy as a bridge therapy in the geriatric age group with acute cholecystitis.

The aim of this study was to investigate the efficacy of percutaneous cholecystostomy (PC) in the geriatric patients with acute cholecystitis. The records of geriatric patients with high surgical risk who underwent percutaneous cholecystostomy for acute cholecystitis were reviewed retrospectively. The median age of 134 patients who underwent percutaneous cholecystostomy was 77 (65-98) years and 63.4% were women. The mean length of hospital stay was 5 (4-18) days, and the follow-up period until the procedure was 2 (1-6) days. Murphy's sign was positive in 79.1% of patients on physical examination, and the remaining patients (20.9%) had only tenderness on examination. As USG findings, 59.0% of the patients had a gall bladder wall thickness (> 4mm) with pericholecystic fluid. Additional imaging method, abdominal CT, was performed in 29 patients (21.6%), MRCP was performed in three patients (2.2%), and ERCP was performed in one patient (0.7%). Bacterial growth was detected in 27.6% of the bile cultures performed. During the follow-up period, laparoscopic cholecystectomy was performed in 60.4% of the patients and open cholecystectomy was performed in 5.2% of the patients electively. 34.3% of the patients did not undergo any surgery. Bile leakage was detected in two patients (1.5%) as a procedure-related complication, and no mortality was observed. Abdominal ultrasonography-guided PC is a safe and effective method in the management of acute cholecystitis in high-risk patients in the geriatric age group.

Missed gall bladder malignancy: A result of ignoring predisposing factors

The underestimation of the prevalence of gallbladder carcinoma, which constitutes a predominant form of malignant neoplasm affecting the biliary tract, poses a significant threat due to its asymptomatic progression. Therefore, this study aimed to analyse the clinical, imaging, and intraoperative outcomes in cases of gallbladder carcinoma. This retrospective investigation was conducted from September 2022 to March 2023 at the Department of General Surgery of FH Medical College. A total of 153 patients deemed suitable for surgery participated in this study and underwent the relevant procedures. Various diagnostic and laboratory tests were administered to the patients, including blood analysis, random blood sugar determination, viral markers, chest X-ray, renal and hepatic functional tests, and comprehensive abdominal ultrasound. Gallbladder specimens were subjected to histopathological examination, and the results were documented and analysed. In histopathological reports, signs of precancerous lesions were noted in 30 out of 153 patients who underwent surgical treatment. The frequency of the disease was higher among women. Among these 30 patients, 22 had ultrasound-diagnosed gallstone disease with acute or chronic cholecystitis, while 8 patients had gallstone disease without gallbladder wall thickening. Additionally, 9 of these patients exhibited focal/irregular/thickening of the wall ≥10 mm. Overall, 16 patients showed elevated liver function, and 4 had an increased glucose level among those with histopathological evidence of precancerous lesions. This study underscores the elusive nature of gallbladder cancer, emphasizing the necessity for a comprehensive assessment, meticulous preoperative evaluation, and a multidisciplinary approach to facilitate early detection and treatment

DETERMINANTS THAT PREDISPOSE TO CONVERSION OF LAPAROSCOPIC CHOLECYSTECTOMY TO OPEN CHOLECYSTECTOMY IN A TERTIARY HEALTH-CARE CENTER IN INDIA

Objectives: The aim of this study was to analyze the patient and disease-related factors of gallstone disease and also to identify pre-operative clinical, laboratory, and ultrasonic predictors that predispose to conversion of laparoscopic to open cholecystectomy. Methods: The study was prospectively conducted over 1-year duration in a tertiary care center in India. Demographic, hematological, and radiological data were recorded for all participants and compared to assess predictors of conversion from laparoscopic to open cholecystectomy. Results: A total of 526 patients participated in the study. Thirty-two cases were converted to open with 6.08% conversion rate. The common intraoperative causes of conversion were frozen Calot’s triangle, dense adhesions, and empyema gallbladder. The significant predictors of conversion were found to be a previous episode of acute cholecystitis (p=0.003), previous upper abdominal surgery (p=0.001), total leukocyte count (p=0.012) with neutrophils (p=0.005), gallbladder wall thickness &gt;5 mm (p=0.0082), and presence of pericholecystic fluid (p=0.0184). Conclusion: The above-mentioned determinants can be used to predict the chances of conversion in a patient planned for laparoscopic cholecystectomy so that the patient can be counseled regarding the risk of conversion and informed consent can be obtained, and the surgical team can be adequately prepared.

FRI088 Vanishing Bile Duct Syndrome?

Abstract Disclosure: C.T. Malvar: None. D. Bleich: None. H. Moran: None. Background: Dyslipidemia is a common metabolic disorder in the US, but only a few conditions can cause a total cholesterol greater than 1000 mg/dl. We present a suspected case of vanishing bile duct syndrome in a patient referred to the emergency department due to transaminitis. Case Report: A 41-year-old female with type 2 diabetes mellitus and alcohol use disorder was found to have abnormal liver function tests. She had jaundice, pruritus, and bipedal edema for 2 weeks, but had quit drinking approximately 2 years ago. She denied any recent travel, sick contacts, prior history of hyperlipidemia, family history of premature CAD or lipid abnormalities. On chart review, she received Azithromycin 2 months before presentation for a presumed upper respiratory tract infection. On evaluation, she had scleral icterus and jaundice. Initial labs revealed Na 117 (133 - 145 meq/l), Cl 84 (97 - 110 meq/l), glucose of 542 (70 - 109 mg/dl), total bilirubin 20.9 (&amp;lt;=1.0 mg/dl), 218 (0 - 33 U/L), AST 133 (0 - 32 U/L), GGTP 778 (5 - 36 u/l), Alkaline phosphatase 2,327 (35 - 105 u/l), Lipase 252 (13 - 60 U/L), Total cholesterol 1329 (100 - 200 mg/dl), LDL 1282 (0 - 99 mg/dl), HDL 13, and Triglycerides 172 (0 - 200 mg/dL). Alpha 1 antitrypsin, Liver Kidney Microsomal (LKM-1) Antibody, ANA, Antimitochondrial antibody, Anti-smooth muscle antibody, Ceruloplasmin, CMV, EBV, HSV, and HIV were all within normal limits. An abdominal CT revealed a right pleural effusion and cholelithiasis without gallbladder wall thickening. A right upper quadrant ultrasound demonstrated hepatic steatosis. Magnetic resonance cholangiopancreatography (MRCP) showed no focal lesions, fatty infiltrations, or ductal dilatation. Ursodeoxycholic acid and cholestyramine were started for pruritus. Pseudohyponatremia was due to the increased lipid fraction in blood. Lipoprotein phenotyping revealed type IIb hypercholesterolemia with elevated triglycerides. An apo-lipoprotein B level was 147 mg/dl at the upper limit of normal (range 50-150 mg/dL). Cholestasis-induced hypercholesteremia was considered as a diagnosis. Endoscopy esophageal ultrasound with liver biopsy revealed a smooth liver with non-cirrhotic appearance, severe cholestatic pattern of injury, including bile duct infarcts, and marked bile ductular reaction. Ezetimibe was started instead of a statin due to elevated liver enzymes. Discussion: Vanishing bile duct syndrome is an extremely rare condition unknown to many clinicians. Patients present after drug-induced liver injury. Treatment focuses on symptomatic relief and supportive care. Hyperlipidemia in these patients minimally respond to statins and are thus avoided. The prognosis of these patients can vary from slow recovery to eventual cirrhosis with end-stage liver disease requiring transplant. Increasing awareness among physicians is essential to facilitate its diagnosis and management. Presentation: Friday, June 16, 2023

DIAGNOSTIC IMAGING AND OROTRACHEAL INTUBATION IN CLINICALLY HEALTHY WILD SUNDA PANGOLINS (MANIS JAVANICA) IN SINGAPORE.

Pangolins are amongst the most overexploited species in the world and all eight species of pangolins are threatened with extinction. These animals are rare in zoological collections and often suffer high mortality rates in captivity. Maintaining healthy populations in captivity has become more important with the declining populations in the wild, but knowledge of veterinary care of these animals is limited. Interpreting radiography and ultrasonography images in a patient can be challenging without knowledge of normal findings. The Wildlife Healthcare and Research Center (WHRC) at Mandai Wildlife Reserve (MWR) admits an average of 25 Sunda pangolins (Manis javanica) annually, which is a Critically Endangered species native to Singapore. All the pangolins are triaged on admission and anesthetized for a health assessment before release into the wild. Endotracheal intubation using an otoscope and stylet is a novel technique in the species that has been developed and is commonly performed with these pangolins. A retrospective study was done on 20 clinically healthy wild pangolins to determine normal ultrasonography and radiography findings in the species. Notable findings include the presence of radio-opaque particles in the stomachs of all pangolins, the presence of free fluid cranial to the left kidney (13/20), a spleen with multifocal hypoechoic regions (6/20), and open epiphyseal plates of long bones even in large individuals weighing as heavy as 6.8 kg. Ultrasonographic images and measurements of kidney, spleen, and adrenal gland sizes as well as intestinal, gallbladder, and urinary bladder wall thickness were also described. These diagnostic imaging findings can advance the veterinary care of captive and wild pangolins.

Incidental gallbladder carcinoma in routine cholecystectomy specimens at tertiary care hospital

Background: Incidental gallbladder carcinoma (IGBC) refers to gallbladder cancer which is not suspected clinically or radiologically and is detected for the first time on histopathological examination (HPE). Aims and Objectives: To find the incidence of IGBC and determine the pathological staging of IGBC accurately as it decides the mode of surgical intervention and thereby increases the quality of life. Materials and Methods: Three years of retrospective study were done from January 2020 to December 2022 at Sheth L. G. General Hospital. Routine histopathological evaluation of 857 such gallbladder specimens was carried out. Fifteen IGBC cases were reported whose pathological staging was done according to American Joint Committee on Cancer and were further analyzed in terms of demographic status, grading, lymph node status, margins, perineural, and lymphovascular invasion. Results: IGBC incidence was 1.75%. Out of 15 IGBC cases, 73% were females. Cholelithiasis was present in 86% of such cases. Gross inspection of all the IGBC-reported specimens revealed thickened gallbladder wall. All cases were adenocarcinoma – pancreaticobiliary type and the most common histologic grade reported was G2. Tumor cells invading the muscularis propria were observed in 7 cases (pT1b), and peri-muscular connective tissue in 7 cases (pT2). Tumor cells invading the serosa were seen in 1 case. (pT3). Conclusion: It is crucial to correctly report the pathologic T stage which determines patient’s survival. The differentiation between pathologic stage pT1a and pT1b should be made cautiously, as this decides the surgical mode of intervention required for increasing the quality of life. In our study, we found the incidence of IGBC to be 1.75%. HPE of all routine cholecystectomy specimens is the gold standard for IGBC detection and is highly recommended irrespective of the radiological diagnosis or macroscopic findings.

Can gallbladder wall thickness and systemic inflammatory index values predict the possibility of conversion from laparoscopy to open surgery?

This study aims to develop an objective marker that predicts the risk of conversion from laparoscopy to open surgery using gallbladder wall thickness and inflammatory index values. A total of 2,920 cholecystectomy patients were screened, including those whose operations were converted to open and those who underwent laparoscopy. A total of 700 cholecystectomy patients who met the study criteria were included in the study. The same team of surgeons performed all operations. The conversion probability from laparoscopic to open cholecystectomy was calculated using the ratio obtained by evaluating inflammatory markers and gallbladder wall thickness (K). The preoperative complete blood count and abdominal ultrasound data of the patients were obtained from our university patient registry system. Age, neutrophil count, gallbladder wall thickness, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), KxNLR, and KxPLR values were all significantly higher in the conversion from laparoscopy to open surgery group compared with the laparoscopic cholecystectomy group. According to the ROC analysis performed on the gallbladder wall thickness values according to the probability of conversion to open surgery, the cutoff value was determined as >3 mm. Gallbladder wall thickness >KxPLR >KxNLR was defined as the diagnostic value order according to the area under the curve. The results of this study showed that gallbladder wall thickness effectively determines the probability of conversion from laparoscopy to open cholecystectomy and multiplying the gallbladder wall thickness (mm) by NLR increased the sensitivity.

The role of preoperative ultrasound in predicting conversion from laparoscopic cholecystectomy to open surgery in acute cholecystitis.

The aim of this study is to evaluate the role of pre-operative ultrasound findings for conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis and to evaluate the effects of pre-operative ultrasound findings on operation time and length of stay. The study included 80 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 1 and June 30, 2023. The relationship between gallbladder wall thickness and the presence of pericholecystic fluid on pre-operative ultrasonography and the duration of surgery, conversion to open surgery, and hospitalization was evaluated. The patient group undergoing open surgery exhibited a statistically significant increase in both the median gallbladder wall thickness (P<0.001) and the frequency of pericholecystic fluid on pre-operative ultrasound (P=0.012). Receiver operating characteristic (ROC) analysis was used to assess the discriminative power of gallbladder wall thickness for predicting the requirement to convert from laparoscopic surgery to open surgery. The area under the curve value was found to be 0.907, indicating a strong discriminative power. Based on the ROC curve, a gallbladder wall thickness of ≥5.75 millimeters showed a sensitivity of 85.7% and specificity of 84.9% in predicting the requirement for open surgery. Our study highlights the significance of two factors in predicting the conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis. The presence of pericholecystic fluid and a gallbladder wall thickness of 5.75 mm or greater are indicators that the laparoscopic procedure may be more challenging in such cases. These results can aid surgeons in making informed decisions and planning the surgical approach accordingly for better patient outcomes.

Pre-operative and Intra-operative Predictive Factors for Conversion of Laparoscopic Cholecystectomy, Wad Madani Teaching Hospital, Gezira State, Sudan; (September 2020 - June 2021)

Background: Laparoscopic cholecystectomy is gold standard for cholecystectomy. Objective: to determine pre- and intra-operative predictive factors for conversion of laparoscopic cholecystectomy to open. Methods: It was a comparative cross-sectional study performed in Wad Madani Teaching Hospital. Total coverage of patients (268 participants) admitted for elective laparoscopic cholecystectomy during (September 2020 - June 2021). Dependent variable: open cholecystectomy; independent: socio-demographical characteristics, co-morbid illnesses, body mass index, drug and surgical history; ultrasound and intra-operative findings. Master sheet, SPSS version 25.0 and Chi square test was used. P ≤ 0.05 was considered statistically significant. Results: Fifty six percent in age group (40-60 years); 87.3% females; 64.3% had normal body mass index; and 53% had history of abdominal surgery. Ultrasound findings: gall bladder wall thickness ≥4 in 91% and wasn’t fibrosed in 63.6%. Intra-operative findings: gall bladder contracted in 54.5%, Twenty-two cases converted to open; 72.3% of them in age group (40-60 years); and 72.3% were female. No statistical association between (socio-demographic characteristics; co-morbid diseases and number of admissions) and conversion of laparoscopic cholecystectomy to open. Regarding ultrasound findings: gall bladder wall thickness &lt; 4 had significant statistical association with laparoscopic cholecystectomy; apart from that there was no significant statistical association with any ultrasound findings and that of both laparoscopic and open cholecystectomy. For intra-operative findings there was statistical association between contracted gall bladder and conversion of laparoscopic cholecystectomy to open surgery. Conclusion: contracted gall bladder is the main factor for conversion of laparoscopic cholecystectomy to open surgery.