International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2015): 78.96 | Impact Factor (2015): 6.391 Volume 6 Issue 3, March 2017 www.ijsr.net Licensed Under Creative Commons Attribution CC BY A Difficult Laparoscopic Cholecystectomy that can be Predicted by Preoperative Ultrasonography: A Single Institution Study M. K. Maheshwari 1 , Himanshu Verma 2 , Zubair Rashid 3 1 Professor, Department of General Surgery, Subharti Medical College, Merrut 2 Junior Resident, Department of General Surgery, Subharti Medical College, Merrut 3 Assistant Professor, Department of General Surgery, Subharti Medical College, Merrut Abstract: Background : The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. Materials and methods : 100 patients undergoing Laparoscopic cholecystectomy at Subharti Medical College, Merrut were included. Sonographic parameters like size of gall bladder, wall thickness, Pericholecystic fluid and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot’s triangle and difficulty in peeling off gall bladder from the bed and Gallbladder retrieval were analyzed. Result : In 4 of 100 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant. Conclusion : Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomy Keywords: Laparoscopic cholecystectomy, Conversion 1. Introduction Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Mouret 1 introduced laparoscopic cholecystectomy in 1987. It has rapidly replaced open cholecystectomy as the standard treatment. Advantages of laparoscopic cholecystectomy include reduced hospitalization, decreased morbidity, short recovery time, and better cosmesis. 2-5 In addition, studies evaluating physiologic and biochemical responses show minimal change in the above parameters. 6 However, compared with open cholecystectomy, the incidence of injuries to the bile duct seems to be increased. 7,8 On the basis of ultrasound findings, surgeons can select the cases appropriate for their skills aiming at reducing operative complications and minimizing the waste of operating time available. 2 Patients with long-standing disease and previous bouts of cholecystitis or pancreatitis are at higher risk of experiencing a difficult procedure or conversion and may be at increased risk of bile duct injury or injury to the adjoining viscera. 7 It would be useful to have some reliable predictive factors for conversion or complications in laparoscopic cholecystectomy. Patients can be selected for laparoscopic cholecystectomy and high-risk procedures and possible complications so that patients can be mentally prepared and can adjust their expectations accordingly. 3 2. Methods The study was conducted in the Department of Surgery,Subharti Medical College, Merrut, India from 2014 to 2016 and included 100 patients. All patients with gallstone disease were included in the study. The patients having concomitant common bile duct stones, suspected malignancy, patients below 10 years, those having features of acute pancreatitis, similarily patients having comorbidities and patients not fit for general anaesthesia were excluded. A detailed clinical history and physical examination were carried out. Complete hemogram, liver function tests, chest X-ray and other preanesthetic investigations were carried out before taking the patient for surgery. Preoperative ultrasonography was performed one day before the surgery. Four ultrasonographic parameters were studied, namely gallbladder wall thickness (more than 3-mm thick gallbladder wall thickness was predicted to be a difficult laparoscopic cholecystectomy); gallstone mobility (gallstone impacted at the neck of the gallbladder was taken to be a difficult laparoscopic cholecystectomy); gallbladder size, that is whether gallbladder is contracted or not (contracted gallbladder was predicted to be a difficult laparoscopic cholecystectomy); Size of the stone; Pericholecystic fluid.The laparoscopic surgery was performed by surgeons at our institution experienced in laparoscopic surgery; therefore, the learning curve statistics do not apply to this study. The operating surgeon was blinded to these findings. The operative findings were objectively graded as difficult or easy laparoscopic cholecystectomy according to the following criteria: more than 90 minutes taken for laparoscopic cholecystectomy from insertion of the Veress needle or trocar (in open method of port insertion) until the extraction of the gallbladder, was considered a difficult laparoscopic cholecystectomy. Tear of the gallbladder during dissection with spillage of bile and stones was considered a difficult laparoscopic cholecystectomy. Any laparoscopic cholecystectomy converted to the open procedure was considered a difficult laparoscopic cholecystectomy. 3. Results A total of 100 laparoscopic cholecystectomies were performed from 2014 to 2016. The mean age of the patients was 45.4 years, and most patients were 41 to 50 years of age. Of 100 patients, only 31 were males. Of 100 Cases, 4 Paper ID: ART20171372 129