Pre-operative sonographic assessment of thick-walled gall bladder in gallstone disease and its influence on the operative outcomes in laparoscopic cholecystectomy

INTRODUCTION: Gall bladder wall thickness (GBWT) on ultrasonography is widely considered a predictor of operative difficulty in laparoscopic cholecystectomy; however, its independent predictive value remains to be fully established. PATIENTS AND METHODS: This prospective, observational study included 196 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy at a tertiary care centre. Patients were stratified into four groups based on GBWT (≤2 mm, 3-4 mm, 5-6 mm and >6 mm). Operative outcomes, including adhesions, operative time, conversion to open surgery and post-operative complications, were analysed. Multivariate logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis determined the optimal GBWT cutoff. RESULTS: Increasing GBWT was significantly associated with higher operative difficulty, including adhesions (16.4% vs. 40.0%, P = 0.023), longer operative time (52.4 vs. 68.2 min, P = 0.002) and higher conversion rates (3.6% vs. 20.0%, P = 0.045). On multivariate analysis, GBWT >2 mm independently predicted adhesions (adjusted odds ratio [AOR]: 1.82, 95% confidence interval [CI]: 1.05-3.14), conversion (AOR: 2.41, 95% CI: 1.08-5.36) and drain placement (AOR: 2.06, 95% CI: 1.12-3.78). ROC analysis demonstrated moderate predictive accuracy (area under the curve 0.72), with an optimal cutoff of >3 mm (sensitivity - 68.5% and specificity - 70.2%). CONCLUSIONS: GBWT is an independent and clinically useful predictor of operative difficulty in laparoscopic cholecystectomy. Routine pre-operative ultrasonographic assessment can aid in risk stratification and surgical planning.