Evaluation of the Role of Ultrasound Findings in Predicting the Difficulty of Laparoscopic Cholecystectomy

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Background and Aim: Understanding the factors contributing to the difficulty of laparoscopic cholecystectomy (LC) enables surgeons to plan more precisely and manage cases more effectively.This study aimed to investigate the predictive role of preoperative ultrasound findings in identifying factors associated with difficult LC. Materials and Methods:This evaluative-diagnostic and analytical study included 150 patients who underwent LC at Shahid Beheshti Hospital in Qom from April 2018 to April 2023.Demographic data and preoperative ultrasound findings, including gallbladder wall thickness, presence of impacted stone, pericholecystic fluid, and palpable gallbladder, were collected.Surgical difficulty was dichotomized into 'easy surgery' (operative time <60 minutes and no complications) and 'difficult surgery' (operative time >60 minutes and/or complications such as uncontrolled bleeding or conversion to open surgery).Data were analyzed using SPSS version 22, with statistical significance set at P<0.05.Results: Among 150 patients (mean age: 46.06±6.82years; 54% female), 22.7% (n=34) experienced difficult surgery.Multivariate analysis revealed that the presence of operative complications was the strongest predictor of surgical difficulty, increasing its odds by 37fold.Gallbladder wall thickness increased the odds of difficult surgery by 2.9 times, and the presence of empyema increased this probability by 3.5 times.In contrast, an impacted stone was unexpectedly associated with a 68% decrease in the odds of difficult surgery.Other variables were not statistically significant.The overall accuracy of the model in predicting surgical difficulty was 83.3%.Conclusion: Preoperative ultrasound findings can significantly predict the difficulty of laparoscopic cholecystectomy, aiding surgeons in preoperative planning and decision-making for optimal patient management.

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