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.