DIAGNOSTIC ACCURACY OF GALL BLADDER WALL THICKNESS ON ULTRASONOGRAPHY IN DETECTING THE CONVERSION FROM LAPAROSCOPIC TO OPEN CHOLECYSTECTOMY

Abstract

Introduction: It is reported that increased gall bladder wall thickness on preoperative ultrasonography can predict difficulties during laparoscopic cholecystectomy.  The rationale of this study is to determine the predictive accuracy of pre-operative ultrasound which if found good, could be a recommended as a standard practice in preoperative evaluation of these patients in our settings as it is readily available, cost effective can give on spot results

Objectives: To determine diagnostic accuracy of gallbladder wall thickness on preoperative ultrasonography in detecting the conversion from laparoscopic to open cholecystectomy, keeping surgical conversion as gold standard.

Main outcome measures: Sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV) and Accuracy

Study design: Cross-sectional (validation) study

Duration of Study:  Six months (20-06-2013 to 31-10-2013) & (01-05-2014 to 30-06-2014)

Settings: Department of Radiology, KRL Hospital Islamabad

Subjects: 110 patients of either gender with age > 20 years who had recurrent pain in right hypochondrium radiating to right shoulder with gallstones on ultrasonography

Methods: Thickness of the gallbladder wallwas measured in each patient through ultrasound a day before the surgery. Information about conversion of  planned laparoscopic cholecystectomy to open cholecystectomy was also recorded for every patient.

Results: Sensitivity, specificity, PPV, NPV and accuracy were found to be 85.71%, 37.86%, 8.57%, 97.5% and 43.67% respectively in this study.

Conclusions: Thickened gall bladder walls on preoperative ultrasonography can predict the possibility of conversion of planned laproscopic cholecystectomy to  open surgery. However, further large scale studies are needed for its validation of its use in routine clinical practice