Abstract

The importance of sonography (US) in the selection of patients for laparoscopic cholecystectomy (LC) is well documented, but its possibilities in forecasting difficulties and complications of the procedure are underreported. The authors performed 735 LCs between January l991 and December 1993. In a prospective study the preoperative US reports were compared with the operative finding in 419 cases. When the stone was impacted into the cystic region, or the gallbladder was enlarged, especially with wall thickening and signs of acute inflammation, the risk of intra- and postoperative difficulties and complications was significantly higher. Fibrosis and scarring of the gallbladder represents an increased risk as well and may be demonstrated by US. The accuracy of evaluating common bile duct (CBD) dilatation is very high. The rate of false positive diagnoses of CBD stones was high because a CBD stone is suspected with the CBD diameter is over 7-8 mm. In spite of this, US is well applicable in patient selection. In the patient group selected on the basis of positive US finding for open cholecystectomy the prevalence of CBD stones was 25% compared with 1.6% in the LC group. US plays a very important role in the differtial diagnosis of postoperative complications and the diagnostic US may be followed with US-guided puncture and/or drainage, occasionally combined with endoscopic stenting.

Keywords: Laparoscopic cholecystectomy, complications, conversion, Patient Selection, sonography, CBD-stone