Prospective study of abdominal ultrasonography before laparoscopic cholecystectomy

To investigate the role of abdominal ultrasonography (US) in predicting possible difficulties during laparoscopic cholecystectomy, we performed preoperative US evaluation prospectively in 82 consecutive patients. We correlated our predictions of "easy" and "difficult" with difficulties experienced at operation in surgery. The binary outcomes were analyzed by taking both easy category of US and surgical operation as positive results and both difficult category as negative results. We obtained satisfactory sensitivity (93.8%), accuracy (81.4%), and positive predictive value (84.7%), but low specificity (35.3%) and negative predictive value (60%). The highly positive results were the result of careful US examination. The low specificity and negative predictive value were attributed to the fact that most surgically difficult cases were due to adhesions around the gallbladder, difficult indeed to detect at US. We conclude that thorough abdominal US examination before laparoscopic cholecystectomy is useful in preoperative evaluation of patients undergoing laparoscopic cholecystectomy, even if it not infrequently fails to predict the surgically difficult cases mainly due to adhesions around the gallbladder.