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SONOGRAPHY TO PREDICT CONVERSION IN LAPAROSCOPIC CHOLECYSTECTOMY

Authors: Gazwan M Khadim --- Zaki A Al-Faddagh
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2010 Volume: 16 Issue: 2 Pages: 26-37
Publisher: Basrah University جامعة البصرة

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Abstract

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

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