Pre-operative Assessment of Difficult Laparoscopic Cholecystectomy by Clinico-Radiological Diagnosis

Background: The gold standard in the treatment of symptomatic gallstones is laparoscopic cholecystectomy, which is one of the most regularly performed surgical operations globally. Ultrasonography is the most common noninvasive, safe, and highly accurate screening test for cholecystitis and cholelithiasis. It can also help surgeons to get an idea of potential difficulty to be faced during surgery in that particular patient. Objective: The objective of this study is to evaluate the role of USG of abdomen to detect the conditions of gall bladder in preoperative diagnosis and their per-operative comparison. Methods: A prospective cross-sectional study was conducted over a period of one and half year from January 2023 to June 2024. A total of 82 patients were included in this study. All Gall stones were diagnosed clinically and radiologically then compared with peroperative difficulties during laparoscopic cholecystectomy. Data were collected from these patients by a preformed questionnaire and finally the data were analyzed by SPSS 29. Results: Most of the patients were female 54 (65.85%). Among them 35(42.68%) cases were present in 41-50 years of age group. Clinically >3 times attack were 58(70.73%). USG of whole abdomen revealed ≥4 mm wall thickness of gall bladder 39(47.56%), contracted gall bladder 41(50%), multiple stones were 61(74.39%) and impacted stones were 11(13.41%). In difficult gall bladder dissection time were > 1 hour 50(60.98%) and conversion to open needed 9(10.98%). Conclusion: The preoperative identification of cases of difficult laparoscopic cholecystectomy is an important advantage not only for the surgeon who has to perform the surgery, but also for the organization of the operating room and technical resources.