Beware the contracted gallbladder - Ultrasonic predictors of conversion

D. P. O'Leary, E. Myers, D. Waldron, J. C. Coffey

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: Pre-operative ultrasound is the gold standard pre-operative investigation for patients undergoing a cholecystectomy. Ultrasound provides a sensitive approach for analysing characteristics of the gallbladder. Thus, we aimed to examine the importance of ultrasonic gallbladder characteristics on laparoscopic cholecystectomy conversion rates and then sought to devise a pre-operative predictive score for conversion based on our findings. Methods: A retrospective analysis of patients undergoing a laparoscopic cholecystectomy was performed between January 2000 and December 2006. Patient demographic data and pre-operative imaging results from abdominal ultrasounds were analysed. We then devised a pre-operative predictive score for conversion based on independent variables derived from multivariate analysis. Results: A total of 1061 patients underwent a laparoscopic cholecystectomy. Conversion to an open procedure was required in 58 cases. The overall conversion rate was 5.4%. Univariate analysis revealed male gender (p<0.0001), gallbladder wall thickness >4mm (p=0.0024), a contracted gallbladder (p=0.005) and a dilated CBD (p=0.0416) as being significantly associated with conversion. These variables were then evaluated using multivariate analysis and three variables, namely, male gender, a contracted gallbladder and a thickened gallbladder wall were identified as independent predictors. A pre-operative predictive score for conversion was devised from a training cohort (n=761) and tested on a sub-cohort (n=300). Patients with a score of 2 or more had a 19.2% risk of conversion (p<0.001). Conclusion: Conversion to an open cholecystectomy shows a strong associated with gallbladder ultrasonic characteristics which are available pre-operatively. The likelihood of conversion can be accurately predicted using a pre-operative scoring system.

Original languageEnglish
Pages (from-to)187-190
Number of pages4
JournalSurgeon
Volume11
Issue number4
DOIs
Publication statusPublished - Aug 2013
Externally publishedYes

Keywords

  • Conversion
  • Laparoscopic cholecystectomy
  • Ultrasound

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