SONOGRAPHY TO PREDICT CONVERSION IN LAPAROSCOPIC CHOLECYSTECTOMY

Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion to laparotomy for safe and successful removal of the gallbladder. This study aimed to look for the various sonographic findings and to make a predictive index for patients who are candidates for laparoscopic cholecystectomy, operative difficulties and conversion to open cholecystectomy. This is a prospective study conducted in the Department of Surgery of Al-Mawani General Hospital, Al-Mousawi Private Hospital in Basrah, Iraq, between May 2005 and October 2008. Abdominal Sonography performed in 105 consecutive patients before laparoscopic cholecystectomy (the sonographic signs are: gallbladder wall thickness, pericholecystic fluid, sonographic Murphy's sign, shrunken gallbladder, number and size of gallstones). Patients excluded are those with history of jaundice, abnormal liver function test, upper abdominal surgery, co-morbid illnesses, extreme obesity, dilated intrahepatic or extrahepatic biliary ducts or those with CBD stones. The surgeon re-evaluates the results of ultrasound with the results obtained during surgery. One hundred and five patients included in the study, 103 patients with gallstones, the other 2 patients having polyps. Ultrasound was accurate 100% in detecting gallstones and polyps, 99 patients (94.3%) have their cholecystectomies via the laparoscope, 75 patient (75.8%) from them show easy procedure, while 24 patients (24.2%) suffered from difficulties. Six patients (5.7%) needed conversion to open cholecystectomy to complete the operation safely. In conclusion, there are many sonographic signs that we can be depend on them to give us an idea about the possibility of conversion to open cholecystectomy, the most specific one is pericholecystic fluid. Secondly gallbladder wall thickness more than 3mm, thirdly, sonographic Murphy's sign, fourthly, shrunken gallbladder, fifthly single gall stone. The other signs are of less specificity like size and multiplicity of gall stones.