Mohammed Azfar Siddiqui MBBS, MD, Presenter: Nothing to Disclose

Ibne Ahmad, Abstract Co-Author: Nothing to Disclose

Syed Amjad Ali Rizvi, Abstract Co-Author: Nothing to Disclose

Ekram Ullah, Abstract Co-Author: Nothing to Disclose

Shagufta Wahab, Abstract Co-Author: Nothing to Disclose

Laparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy (OC) mainly because of technical difficulty. Our aim was to develop a standardized Ultrasound-based scoring system for preoperative prediction of difficult LC.

Ultrasound findings of 300 patients who underwent LC by a single experienced surgeon were reviewed retrospectively. Four parameters (time taken, biliary leakage, injury to duct or artery, and conversion to OC) were analyzed to classify LC as easy or difficult. The ultrasound findings were analyzed with emphasis on GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. A score of two was assigned for presence of each finding with a total score of 14. A cut-off value of 6 was taken to predict easy (score of 6 or less) and difficult laparoscopic cholecystectomy (score more than 6). The sensitivity, specificity along with positive predictive values for predicting easy and difficult cases were calculated.

58 out of 67 cases of difficult LC and 208 out of 233 cases of easy LC were correctly predicted on the basis of this scoring system. A score of 6 had a sensitivity 69.6% and specificity 95.8 % for correctly identifying difficult LC. Prediction came true in 89.3% for easy and 86.6% difficult cases. Ultrasound findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant with p-value<0.005.

This indigenous scoring system is very effective in predicting conversion risk of LC to OC.

Patients having high risk may be informed and scheduled appropriately. Decision to convert to OC in case of anticipated difficulty may be taken earlier with the help this scoring system.

Siddiqui, M, Ahmad, I, Rizvi, S, Ullah, E, Wahab, S, An Indigenous Standardized Ultrasound Scoring System for Preoperative Prediction of Difficult Laparoscopic Cholecystectomy.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11005749.html