An Analytical Study on the Relationship Between Preoperative Ultrasound Findings and Intraoperative Challenges in Elective Laparoscopic Cholecystectomy

Abstract

INTRODUCTION: Cancer is a major health problem in many countries including India. Since Cancer Registries are incomplete in India, only a few epidemiological studies have been done so far. The objective was to determine to examine the various factors influencing the incidence of gastric carcinoma
Stomach cancer remains a major cause of cancer-related deaths worldwide, with a low 5-year survival rate (<30%) due to late diagnosis. Adenocarcinoma, the most common type, is linked to Helicobacter pylori infection. Though India has a relatively low incidence, urbanization and dietary shifts are contributing to its rise. Early detection in Japan has improved survival rates, unlike most regions. Surgical removal is the only effective treatment, but recurrence remains a challenge. Efforts are ongoing to develop adjuvant therapies for better outcomes.
AIM: The study aims to improve the prediction of intraoperative complications
during lap cholecystectomy by comprehending and using preoperative USG data and criteria.
OBJECTIVES:
 To establish a relationship between intraoperative challenges and preoperative gall bladder ultrasonography results.The aim of this study is to evaluate the sensitivity and specificity of preoperative USG findings related to the gall bladder and to forecast the
 likelihood of a conversion to Laparoscopic cholecystectomy in order to do an open cholecystectomy as soon as feasible during surgery.
MATERIALS AND METHODS
This prospective analytical study was conducted in the General Surgery Department at KARPAGA VINAYAGA INSTITUTE OF MEDICAL SCIENCE, Chengalpettu, from September 2022 to July 2024. Fifty-seven patients undergoing elective laparoscopic cholecystectomy were assessed using preoperative ultrasound for parameters like gallbladder wall thickness, pericholecystic fluid, stone characteristics, and CBD size. Intraoperative challenges, including bleeding, bile leakage, operative time, and dissection difficulty, were documented. Statistical analysis was performed using unpaired t-tests and chi-square tests, with significance set at p < 0.05. The study aimed to correlate preoperative ultrasound findings with surgical complexity. List of variables Studied Based on USG findings
• Gall bladder wall thickness
• Pericholecystic fluid
• Gall bladder size
• Size of gall stone
• Number of gall stone
• Location of gall stone
• Common bile duct size
• Vascularity around calot’s triangle
• Abberant anatomy
Based on intra-operative difficulties
• Total duration of surgery from the insertion of working ports to the
extraction of gall bladder
• Total time taken to dissect the Calot’s Triangle
• Total time taken to dissect the gall bladder from the gall bladder bed
• Tear of gall bladder & spillage of bile and stone
• Bleeding
• Extraction of gall bladder
Expected outcome:
• Better correlation of intraoperative difficulties with pre-clinical USG
findings
• Reduced duration of surgery.
• Avoiding complications during the procedure.
• Better predictions of complication during the during and be prepared for it
• Reducing morbidity and mortality of the patient.
• Enhancement of patient education on the necessity and likelihood of
undergoing an open cholecystectomy
Outcome variables
• Distribution of duration of surgery (in minutes) in study population
• The study population's dissection time distribution for the gall bladder bed (in
minutes)
• The research population's dissection time distribution in minutes
• The research population's distribution of gall bladder extraction times
• The incidence of gallstones and bile spills among patients with and without
gallbladder tears
• The surgical conclusions drawn by the operating surgeon on the study
population
• The research population's gall bladder wall thickness distribution (in mm)
• Link between ultrasonographic parameters and intraoperative bleeding?
• Correlation between ultrasonographic parameters and surgical duration
• Correlation between ultrasonographic characteristics and the amount of time
required to dissect the gall bladder bed:
• Using ultrasonographic parameters to determine how long it takes to dissect
Calot's triangle
• Correlation between ultrasonographic parameters and the amount of time
required to extract the gall bladder
• Association of ''Tear of gall bladder and spillage of stones and bile'' with
ultrasonographic parameters.
STATISTICAL ANALYSIS: We used proforma and input all of the data into an Excel spreadsheet. Mean, standard deviation, frequency, and percentage were used to summarise the data. Tables, figures, a bar chart, and a pie chart were used to display the summarised data. A chi-square test was used for categorical data and an unpaired t-test for summarised data to compare with mean difference. A p-value below 0.05 was deemed statistically significant for all purposes.
RESULTS: The average age of patients was 48.5 years, with females accounting for 77.2% of the cases. Ultrasound findings revealed that 89.5% had a normal gallbladder size, 84.2% had multiple gallstones, and 21.1% had stones larger than 1 cm. Additionally, 10.5% had a common bile duct (CBD) diameter exceeding 8 mm, while 12.3% had impacted stones at the gallbladder neck, and 19.3% exhibited a gallbladder wall thickness greater than 4 mm. Significant associations were noted between abnormal anatomy, increased gallbladder wall thickness, and CBD dilation with prolonged surgical duration (>120 minutes). A gallbladder wall thickness over 4 mm was also linked to longer dissection times of Calot’s triangle (>20 minutes). Bile spillage and gallbladder perforation occurred in 14% of cases, strongly correlating with impacted stones and thickened gallbladder walls.
Conclusion: Preoperative ultrasound serves as an effective tool for anticipating intraoperative challenges in laparoscopic cholecystectomy. Key ultrasound parameters, such as gallbladder wall thickness, common bile duct diameter, and stone characteristics, offer valuable insights into potential complications and the likelihood of conversion to open cholecystectomy. Integrating these findings into preoperative planning can improve surgical efficiency and patient care.