FAILED OR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY - CAN PREOPERATIVE ULTRASONOGRAPHY IDENTIFY POTENTIAL PROBLEMS

A prospective study was performed to assess the role of preoperative u ltrasonography in predicting failed or difficult laparoscopic cholecys tectomy. Fifty patients underwent detailed preoperative ultrasound exa minations. The number and size of calculi, evidence of acute or chroni c cholecystitis, gallbladder morphology, and the presence or absence o f aberrant anatomy were documented. A comparison was made of the surgi cal outcome and the ultrasound findings in each patient. Six patients were converted to open cholecystectomy because of inflammatory changes in the gallbladder. The preoperative ultrasound studies in 5 of these patients demonstrated evidence of cholecystitis and cholelithiasis. G allbladder wall thickening and contraction were also seen. Five gallbl adder resections had intraoperative difficulties; preoperative ultraso nography demonstrated a thickened gallbladder wall in 2. Of 31 unevent ful cases, 7 had evidence of gallbladder wall thickening and/or contra ction. There were no ultrasound features that identified between the u nsuccessful, difficult, or uneventful laparoscopic cholecystectomies. We conclude that detailed preoperative ultrasound evaluation of the ga llbladder in patients destined for laparoscopic cholecystectomy is of little value in screening for difficult or unsuitable cases. (C) 1994 John Wiley and Sons, Inc.