Ulus Travma Acil Cerrahi Derg. 2023; 29(10): 1109-1113 | DOI: 10.14744/tjtes.2023.45469

The role of preoperative ultrasound in predicting conversion from laparoscopic cholecystectomy to open surgery in acute cholecystitis

Saygýn Altýner, Ender Ergüder, Saliha Hazal Altýnok, Seyit Murat Aydýn, Aziz Mutlu Barlas, Salih Tuncal
Department of General Surgery, Ankara Training and Research Hospital, Ankara-Türkiye

BACKGROUND: The aim of this study is to evaluate the role of pre-operative ultrasound findings for conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis and to evaluate the effects of pre-operative ultrasound findings on operation time and length of stay.
METHODS: The study included 80 patients who underwent laparoscopic cholecystectomy for acute cholecystitis between January 1 and June 30, 2023. The relationship between gallbladder wall thickness and the presence of pericholecystic fluid on pre-operative ultrasonography and the duration of surgery, conversion to open surgery, and hospitalization was evaluated.
RESULTS: The patient group undergoing open surgery exhibited a statistically significant increase in both the median gallbladder wall thickness (P<0.001) and the frequency of pericholecystic fluid on pre-operative ultrasound (P=0.012). Receiver operating characteristic (ROC) analysis was used to assess the discriminative power of gallbladder wall thickness for predicting the requirement to convert from laparoscopic surgery to open surgery. The area under the curve value was found to be 0.907, indicating a strong discriminative power. Based on the ROC curve, a gallbladder wall thickness of ≥5.75 millimeters showed a sensitivity of 85.7% and specificity of 84.9% in predicting the requirement for open surgery.
CONCLUSION: Our study highlights the significance of two factors in predicting the conversion from laparoscopic cholecystectomy to open surgery in patients with acute cholecystitis. The presence of pericholecystic fluid and a gallbladder wall thickness of 5.75 mm or greater are indicators that the laparoscopic procedure may be more challenging in such cases. These results can aid surgeons in making informed decisions and planning the surgical approach accordingly for better patient outcomes.

Keywords: Acute cholecystitis, laparoscopy; pre-operative ultrasonography.

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Akut kolesistitte preoperatif ultrasonografinin laparoskopik kolesistektomiden açýk cerrahiye geçiþi tahmin etmedeki rolü

Saygýn Altýner, Ender Ergüder, Saliha Hazal Altýnok, Seyit Murat Aydýn, Aziz Mutlu Barlas, Salih Tuncal
Ankara Eðitim ve Araþtýrma Hastanesi, Genel Cerrahi Anabilim Dalý, Ankara, Türkiye

AMAÇ: Bu çalýþmanýn amacý, akut kolesistitli hastalarda laparoskopik kolesistektomi sýrasýnda açýk cerrahiye geçiþ için preoperatif ultrason bulgularýnýn rolünü deðerlendirmek; ayrýca operasyon ve yatýþ süreleri üzerine etkilerini deðerlendirmektir.
GEREÇ VE YÖNTEM: Çalýþmaya 1 Ocak – 30 Haziran 2023 tarihleri arasýnda akut kolesistit sebebiyle laparoskopik kolesistektomi tekniðiyle ameliyata baþlanan 80 hasta dahil edildi. Preoperatif ultrasonografide kese duvar kalýnlýðý ve perikolesistik mayi varlýðý ile ameliyat süresi, açýk cerrahiye geçme ve hastanede yatýþ süreleri arasýndaki iliþkisi deðerlendirildi.
BULGULAR: Safra kesesi duvar kalýnlýðý, açýk cerrahiye geçilen hastalarda 7.0 (6.0- 8.0) mm iken, diðer grupta 5.0 (4.0- 5.0) mm ölçüldü ve fark istatistiksel olarak anlamlýydý(p<0.001). Ayrýca preoperatif ultrasonografide perikolesistik mayi bulunmasý açýk cerrahiye geçilen ve laparoskopik tamamlanan hasta gruplarý arasýnda deðerlendirildiðinde istatistiksel olarak anlamlý fark bulundu (p=0,012). Safra kesesi duvar kalýnlýðýnýn ameliyatýn açýk cerrahiye geçilmesinde ayýrt edici gücü ROC analizi ile deðerlendirildi. Area Under Curve (AUC) deðeri 0.907 olarak saptandý. ROC eðrisine göre safra kesesi duvar kalýnlýðý ≥5.75 milimetre için duyarlýlýk ve özgüllük yüzdesi sýrasýyla, %85.7; %84.9 bulundu.
SONUÇ: Akut kolesistit ataðý geçiren hastalarda, perikolesistik mayi bulunmasý ve safra kesesi duvar kalýnlýðýnýn 5.75 mm ve daha büyük olmasýnýn laparoskopik kolesistektominin teknik olarak daha zor geçeceðini gösteren faktörler olarak deðerlendirilebilir.

Anahtar Kelimeler: Akut kolesistit, laparoskopi; preoperatif ultrasonografi.

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