GB Wall Thickness Research Articles

Ultrasound Measurement of the Gallbladder Wall Thickness in the Assessment of the Risk of Conversion from Elective Laparoscopic Cholecystectomy to Open Surgery - Olkusz County Experience.

A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χ2) independence test was used, and the results were interpreted for the significance threshold of α = 0.05. The relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444-0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121-0.738; p = 0.001). The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.

Pre-operative prediction of difficult laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of cholelithiasis and is replacing open cholecystectomy. The rate of conversion from laparoscopic cholecystectomy to open cholecystectomy is 5 to 10%. Hence it is necessary to study the predictive factors for difficult laparoscopic cholecystectomy. Methods: All patients are subjected to ultrasonographic evaluation. The patients confirmed by USG examination are evaluated with following factors: age, sex, BMI, h/o previous hospitalization, h/o previous abdominal surgeries, h/o acute cholecystitis / pancreatitis. Sonographic findings: GB wall thickness (>/ 32.5, history of cholecystitis, previous abdominal surgery, GB wall thickness>3mm, pericholecystic collection, multiple stones and liver fibrosis were significant predictors of difficult laparoscopic cholecystectomy. Conclusions: In about 5 to 10% of the cases of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Therefore it is necessary to analyse the risk factors that predict difficult laparoscopic cholecystectomy.

Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment.

Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy. To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion. This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test. Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion. The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection.

Sonographic evaluation of abdominal organs in a sickle cell disease patient

Background: SCD is one of the most common inherited hemoglobinopathies worldwide. It forms a major health problem in Madhya Pradesh and surrounding states. The present study was undertaken to infer the value of ultrasonography in evaluating abdominal organs in a SCD patient. Study design: This is a prospective hospital based study. Method: 100 SCD patients were assessed for abdominal pathologies by USG, the results thus analyzed and prevalence was calculated. Result: Hepatomegaly is the most common association observed in 69% of patients followed by splenomegaly in 31% patients & increased renal size in 29% patients. Cholelithiasis (17%), increased renal medullary echogenecity (14%), Auto-splenectomy (11%), Bright liver (9%), Splenic calcification (8%), Increased GB wall thickness (6%), Splenic infarct (5%) and Increased pancreatic echogenicity(3%) are the other associated findings. Conclusion: Real time ultrasonography is a simple, cheap, rapid, easily accessible, non-invasive, non-ionizing screening procedure in all cases of SCD patient for assessment of pathological changes occurring in the various abdominal organs. The high rates of abdominal pathologies being diagnosed on ultrasonography underscores the need for it to be established as a standard screening procedure with established protocols.

English

INTRODUCTION: Laparoscopic Cholecystectomy has evolved as the standard of care for the treatment of Gall Stone disease over the past decade. Several patient and procedure related factors have been implicated in setting of failure to complete the procedure by minimal invasive method and various scores have been developed to precisely predict a Difficult Laparoscopic Cholecystectomy. AIMS: The present study was conducted to ascertain various patient related preoperative risk factors for conversion of laparoscopic Cholecystectomy to open method and to validate the Risk Score for conversion. SETTINGS & DESIGN: A total of 100 patients with diagnosis of Gall Stone Disease admitted to our surgical Unit between October 2011 and April 2013 were assessed for various pre-determined risk factors and were accordingly categorized into three levels of anticipated difficulty according to RSCLO and our new scoring system. The patients were then subjected to Laparoscopic Cholecystectomy by the same surgical team and the procedure was then graded as difficult or not according to the pre-defined criteria. The findings were analysed by appropriate statistical analysis. RESULTS: Presence of factors like Male sex, history of attacks of acute cholecystitis, increased GB wall thickness, presence of supra-umbilical abdominal scar, obesity and a contracted GB were associated with a significantly higher rate of conversion to open method. RSCLO was found to correlate better with the outcome in this setting than our New Scoring System. CONCLUSION: Several patient related factors may be helpful in predicting a Difficult Laparoscopic Cholecystectomy pre-operatively. RSCLO Scoring system may be useful as a pre-operative tool to predict intra-operative difficulty during LC.

Sonographic Evidence of Ascites, Pleura-Pericardial Effusion and Gallbladder Wall Edema for Dengue Fever

Radiographic findings of dengue fever have not yet been clearly elucidated in relation to clinical and serological findings, despite the fact that two-fifths of the world population lives in areas where the virus is endemic. The current study is a retrospective analysis of ultrasonographic (USG) features of patients presenting with probable dengue fever during the outbreak of DF of 2006 in North India. Case records of a 169 patients with probable dengue fever were included. Ten individual sonographic parameters were reviewed vis-à-vis ascites, hepatomegaly, splenomegaly, gall bladder wall edema (GBWE), pleural effusion (right or left or both), pericardial effusion, pericholecystic collection, perinephric collection. Subjects who had GB wall thickness >3 mm as measured on ultrasound were identified as positive for GBWE. The cases were analyzed in view of their serological profile. The mean age of the subjects was 27.9 +/- 13.4 years. The mean value of the platelet count was 57.4 +/- 22.3 x 103/cmm. The most common ultrasonographic feature was ascites (126, 74.6%) followed by gall bladder wall edema (122, 72%), hepatomegaly (78, 46.2%), splenomegaly (66, 39.1%) and pericholecystic collection (63, 37.3%); 48 (28.4%) subjects demonstrated evidence of pleural effusion on the right side, while 19 (11.2%) had bilateral effusion. None of the subjects had an isolated left pleural effusion. Twenty-seven (16%) subjects reported bleeding manifestations in the form of petechiae and five (3%) developed renal dysfunction. Presence of pleural and pericardial effusions was found to be specific while ascites and GBWE were identified as highly sensitive markers for seropositive Primary DF. Ultrasonographic evidence of ascites, pleuro-pericardial effusion, and gallbladder wall edema are rapidly acquired, non-invasive markers of dengue and can be helpful before serological investigations become available. These findings may indicate severity and may herald the onset of bleeding (petechiae) or predict the development of acute renal dysfunction.

274 Acute Acalculous Cholecystitis in Children: A 10-Year Retrospective Study in a Single Center

Objective: The aims of this study were to define the etiology, clinical presentation, and prognosis of acute acalculous cholecystitis (AAC) in children.Methods: Children aged less than 18 years diagnosed with AAC were analyzed retrospectively between 2000 and 2009. The demographic and clinical characteristics, etiology, and outcome were recorded. AAC was defined as GB wall thickness of greater than 3.5 mm and duration of symptoms less than 1 month. The severity of sonographic findings were scored, with 1 point each given for wall thickness greater than 3.5 mm, GB distention, sludge, and pericholecystic fluid.Results: A total of 109 children (male/female =1.18, mean age = 5.8 years) were diagnosed with AAC. The most common presentation was fever (88%), followed by hepatomegaly (73%) and jaundice (49%). 65% and 72% of patients had thrombocytopenia and elevated alanine aminotransferase, respectively. The common causative etiologies were infectious diseases (58%) and systemic illnesses (27%). In addition to the wall thickening, the most frequent sonographic finding was GB distension (34%), followed by sludge (15%), and pericholecystic fluid (14%). All of our patients were treated non-operatively. Sixteen (15%) patients died. Children with mortality had a significantly higher rate of shock (p< 0.001), anemia (p=0.01), thrombocytopenia (p=0.04), hypofibrinogenemia (p=0.002), presence of pericholecystic fluid, and higher sonographic scores (p=0.04) than those with survival.Conclusion: Childhood AAC may be secondary to a variety of etiologies, especially during the course of infectious diseases. Presence of shock and a low value of fibrinogen are predictable factors for mortality in childhood AAC.