Polski przeglad chirurgiczny · 2016
Ultrasound Measurement of the Gallbladder Wall Thickness in the Assessment of the Risk of Conversion from Elective Laparoscopic Cholecystectomy to Open Surgery - Olkusz County Experience.
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Kania Dariusz
Аннотация
UNLABELLED: The aim of the study was to assess the risk of intraoperative difficulties, conversion and biliary-intestinal fistula during laparoscopic cholecystectomy on the basis of an ultrasound-measured gall-bladder wall thickness.
MATERIAL AND METHODS: A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χ2) independence test was used, and the results were interpreted for the significance threshold of α = 0.05.
RESULTS: The relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444-0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121-0.738; p = 0.001).
CONCLUSIONS: The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.
MATERIAL AND METHODS: A prospective study was conducted in 50 patients undergoing laparoscopic cholecystectomy for chronic gallstone-induced cholecystitis. To calculate the relationships between categorical variables, a chi-square (χ2) independence test was used, and the results were interpreted for the significance threshold of α = 0.05.
RESULTS: The relationship between the gall-bladder wall thickness and the occurrence of intraoperative difficulties in the analysed set is deterministic (AUC = 1), and the wall thickness of ≥ 5 mm allows to predict their occurrence as soon as at the stage of diagnostic evaluation (p < 0.001). In addition, the ultrasound-measured GB wall thickness is a good predictor of conversion (AUC = 0.976; 95% CI 0.444-0.975; p < 0.001) and biliary-intestinal fistula (AUC = 0.935; 95% CI 0.121-0.738; p = 0.001).
CONCLUSIONS: The results allow prediction of technically difficult laparoscopic cholecystectomies in patients with CCh, and selection of the right surgical team helps to reduce the number of conversions and possible complications. In addition, bearing in mind the above results in everyday practice should facilitate planning and increase effectiveness in the operating room.