Laparoscopic Cholecystectomy a gold standard treatment for symptomatic Gall stone diseases

Background: Laparoscopic cholecystectomy is the gold standard for surgical treatment of symptomatic gallstone disease. But, a thickened gall bladder (GB) wall on the pre-operative ultrasonography might predict the difficulty of the operation, conversion to open surgery, post-operative complications, and longer hospital stay. This study was conducted to assess the correlation of the thickness of the GB wall in the preoperative period with the surgical outcomes in patients undergoing laparoscopic cholecystectomy. Material and Methods: This is a prospective observational study, incorporating 54 consecutive patients undergoing elective laparoscopic cholecystectomy from August 2022 to August 2024. Pre-op ultrasonography was used to assess GB wall thickness (grade I: 1-2mm, grade II: >2-3mm, grade III: >3-4mm, grade IV: >4mm). The type of cholecystitis, conversion to open cholecystectomy, postoperative complications and length of hospital stay were assessed. Results: Of the 54 patients, female patients were more predominant (64.81%) and 74.07% of the patients had calculous cholecystitis. The most prevalent were Grade II (35.19%) and Grade III (33.33%) GB wall thickness. Six patients (11.11%) had to be converted to open cholecystectomy, the rate being the highest in Grade IV patients (50%). The mean GB wall thickness was significantly higher in patients requiring conversion compared with those who completed laparoscopic surgery (4.47±0.21 mm vs. 2.96±0.12 mm; p<0.0001). 18.52% of the patients developed postoperative complications, most of them being bile leak (12.96%) and surgical site infection (11.11%) with the highest incidence in Grade IV. The postoperative hospital stay was significantly longer with the higher GB wall thickness (p=0.0004), and converted cases had significantly longer hospital stay compared to the laparoscopic cases (5.33±0.49 vs. 3.65±0.13 days, p=0.0001). Conclusion: Preop USGW is a simple and reliable predictor of the difficulty of surgery during LC. Grade III and Grade IV wall thickness has been shown to be statistically significant risk factors for conversion to open surgery, postoperative complications and longer hospital stay. Regular evaluation of GB wall thickness can help in pre-operative risk stratification, surgical planning and counseling.

Keywords: Gallbladder wall thickness; Laparoscopic cholecystectomy; Ultrasonography; Conversion to open cholecystectomy; Postoperative complications.