[Relation of pre-operative ecography to laparoscopic cholecystectomy difficulty at the Central Military Hospital]

This study included 62 patients diagnosed with known vesicular disease, who underwent laparoscopic cholecystectomy between August 1999 and March 2000, at the Central Military Hospital. Those patients showing alterations in the hepatic function tests and dilatation of the biliary tract in the pre-operative echography were excluded from the study. The patients selected were subjected to evaluation of the echographic parameters one day before the surgery in order to determine the vesicular volume and ejection fraction. The maximum ejection fraction was calculated as the difference between the fasting gastric volume and the residual volume, in the fasting volume percentage. We evaluated the above-mentioned operative parameters one day following the laparoscopic cholecystectomy, using a visual analog scale (VAS) for evaluation of the surgical difficulty and bleeding during surgery. The surgery duration was measured in minutes. Subsequently, the pre-operative echographic parameters, excluding the ballstone parameter in the main biliary tract, were related to the surgery parameters, obtaining the following results: -The pre-operative echographic parameters, thickness of the vesicular wall and vesicular ejection fraction, are the best indicators of surgical difficulty in laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction <50% and vesicular wall thickness = 3 mm are indicators of larger bleeding during laparoscopic cholecystectomy. -The pre-operative echographic parameter, vesicular ejection fraction in gallbladder indicates prolongation of surgery duration in laparoscopic cholecystectomy. -Finally, our study supports the use of echography as a useful diagnosis mean in patients undergoing laparoscopic cholecystectomy, and which can predict, through some of its echographic parameters, cases with technical difficulty, bleeding during surgery and prolongation of surgery time in laparoscopic cholecystectomy.