To Determine the Diagnostic Accuracy of Gallbladder Wall Thickness and Presence of Pericholecystic Fluid in Predicting the need for Conversion of Laparoscopic Cholecystectomy to Open Cholecystectomy in patients with Cholelithiasis

Background: The prevalence of cholelithiasis is high and approximately every third woman and every fifth man are affected. Certain conditions preclude laparoscopic cholecystectomy leading surgeons to perform conventional open cholecystectomy. In this study we have determined that gallbladder (GB) wall thickening and pericholecystic fluid, on sonography are best predictors of conversion from laparoscopic cholecystectomy to open cholecystectomy in our population. Aim: To determine the diagnostic accuracy of GB wall thickness >4mm and pericholecystic fluid in predicting the need for conversion of lap. Chole. to open cholecystectomy in patients with cholelithiasis. Methods: The current cross sectional validation study was done at Radiology department, Military Hospital, Rawalpindi for the period of six months from June till December 2013. 249 patients were included in the study with an average age of 35 years. Results: The sensitivity, specificity, positive and negative predictive value as well as accuracy of wall thickening >4 mm as an indicator of surgical conversion were 88.5%, 91.5%, 74.2%, 96.8% and 91.2% respectively and for pericholecystic fluid were of 57.7%, 97.0%, 83.3% 89.7% and 88.7% respectively. Out of 249 cases 52 were converted to open cholecystectomy with conversion rate of 20.9%. Conclusion: Sonography should play a central role in surgical planning. Gallbladder wall thickening and pericholecystic fluid on sonography are the best predictors for converting a patient from laparoscopic cholecystectomy to open cholecystectomy.