CORRELATION OF PREOPERATIVE ULTRASONOGRAPHIC GALLBLADDER WALL THICKNESS WITH OPERATIVE DIFFICULTY DURING CHOLECYSTECTOMY: AN OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL IN BIHAR
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Keywords
Gallbladder wall thickness; Cholelithiasis; Cholecystectomy; Operative difficulty; Ultrasonography; Surgical outcomes; Gallstone disease
Abstract
Background: Laparoscopic cholecystectomy is the standard treatment for symptomatic gallstone disease. However, operative difficulty may arise due to inflammatory changes, adhesions, and distortion of biliary anatomy. Identification of reliable preoperative predictors of difficult cholecystectomy is important for surgical planning and risk stratification. Gallbladder wall thickness measured by ultrasonography has been proposed as a potential predictor of operative difficulty.
Objectives: To evaluate the correlation between preoperative ultrasonographic gallbladder wall thickness and operative difficulty during cholecystectomy in patients with symptomatic gallstone disease.
Methods: A hospital-based observational analytical study was conducted in the Department of General Surgery at a tertiary care hospital in Bihar from August 2005 to November 2005. Thirty-four consecutive patients with symptomatic cholelithiasis undergoing cholecystectomy were enrolled. Preoperative ultrasonography was performed to assess gallbladder wall thickness. Intraoperative difficulty was evaluated using predefined criteria including dense adhesions, difficulty in Calot’s triangle dissection, operative duration, intraoperative bleeding, and conversion to open surgery. Statistical analysis was performed using SPSS version 11.0. Associations were assessed using the Chi-square test, while correlation was evaluated using Spearman’s rank correlation coefficient. A p-value <0.05 was considered statistically significant.
Results: Among the 34 patients studied, females constituted 70.6% of the study population. Gallbladder wall thickness greater than 3 mm was observed in 41.2% of patients. Dense adhesions and difficult Calot’s triangle dissection were the most common indicators of operative difficulty. Difficult surgery occurred in 64.3% of patients with gallbladder wall thickness greater than 3 mm compared with 15.0% of those with wall thickness of 3 mm or less. A statistically significant association was observed between increased gallbladder wall thickness and operative difficulty (p=0.006). Gallbladder wall thickness also demonstrated a moderate positive correlation with operative difficulty score (Spearman’s ρ = 0.52, p=0.002).
Conclusion: Preoperative gallbladder wall thickness is significantly associated with operative difficulty during cholecystectomy. Ultrasonographic measurement of gallbladder wall thickness may serve as a useful and practical predictor of technically difficult surgery, thereby aiding preoperative planning and patient counseling.
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Dr. Hira Prasad Singh
Assistant Professor, Department of General Surgery, Katihar Medical College & Hospital, Katihar, Bihar, India.
Dr. Vinod Kumar
Assistant Professor, Department of General Surgery, Katihar Medical College & Hospital, Katihar, Bihar, India.
