Could preoperative sonographic criteria predict the difficulty of laparoscopic cholecystectomy?

Although laparoscopic cholecystectomy (LC) is the gold standard approach for gallbladder diseases, this sometimes may face difficulties and require conversion to open surgery. The preoperative ultrasonographic study may provide information about the probability of difficult LC, but the data in this term are uncertain. We assessed the value of preoperative ultrasonographic findings for the prediction of LC's difficulty.

The current prospective clinical trial was conducted on 150 patients who were candidates for LC due to symptomatic gallstone. All of the patients underwent ultrasonography study preoperatively, and then, LC was performed. The surgeon completed a checklist regarding the easy or difficult surgical criteria. Finally, the values of ultrasonographic findings for the prediction of LC difficulty were evaluated.

Among the 150 included patients, 80 had easy LC and 70 had difficult LC. Statistically significant differences were found between the two groups of easy and difficult LC regarding gallbladder wall thickness (P = 0.008), stone impaction (P = 0.009), and gallbladder flow (P = 0.04). The area under the curve (standard error [SE]) for the thickness of the gallbladder wall, flow in the gallbladder wall, and stone impaction was 0.598 ± 0.048, 0.543 ± 0.047, and 0.554 ± 0.047, respectively (P < 0.05). The highest specificity was for gallbladder wall flow (100%). Binary logistic regression showed that stone impaction had predictive value for determining difficult LC (odds ratio = 3.10; 95% confidence interval: 1.03-9.30; P = 0.04).

Although a significant difference was observed between two groups in terms of impacted stone, flow in the gallbladder wall, and thickness of the gallbladder wall, only stone impaction had predictive value for determining difficult LC.