Junaid Zaman, Syed Imaduddin, Rahila Razzak.
Frequency of difficult laparoscopic cholecystectomy in patients with thick walled gall bladder.
Pak J Surg Jan ;31(3):165-8.

Introduction: Laparoscopic cholecystectomy is the procedure of choice for chronic calcular cholecystitis. Th ere are variable rates of conversion of laparoscopic cholecystectomy to open cholecystectomy. Various studies have highlighted gall bladder wall thickness and age as independent risk factors for conversion from laparoscopic to open procedure. Th is study was done to determine the frequency of conversion of laparoscopic cholecystectomy to open cholecystectomy in patients undergoing laparoscopic cholecystectomy with a gall bladder wall thickness of more than 3mm as determined on pre operative ultrasound. Methodology: Th is retrospective study was conducted at the Surgical Unit IV Civil Hospital Karachi, Pakistan from 15th July 2012 to 15th January 2013. A total of 129 patients were included in the study with gall bladder wall thickness of more than 3mm on Ultrasound. Patients were stratifi ed according to age, sex, gall bladder wall thickness, frequency of diffi cult cholecystectomy and duration of disease. Results: A total of 129 patients were included in the study. Female to male ratio is 5.7:1. Th e mean age of patients was 43.33±11.5 years. Th e average gall bladder wall thickness was 4.07±0.63 mm and duration of disease was 4.53±4.67 years. Regarding preoperative fi ndings, bleeding during dissection of the gall bladder from the liver bed was the commonest fi nding in our study i.e. 35.7% followed by local adhesions 33.3% and perforation of gall bladder was observed in 7.8% cases. All (n=13) patients who had conversion to an open procedure had wall thickness between 4.1 to 6 mm. Similarly rate of conversion was found to be in higher in patients with symptoms for more than 5 years (i.e. 9 out of 24) Conclusion: Ultrasound for gall bladder wall thickness is a good predictor for diffi cult cholecystectomy. It should be used as anticipative measure for diffi cult cases and patient should be properly counseled for possibility of conversion to open cholecystectomy.

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