K. Venagtesan1, J. Santos1, T. S. Brahmbhatt1, S. Sanchez1, C. Narsule1, B. Sarkar1, C. LeBedis1, A. Gupta1, G. Kasotakis1 1Boston University,School Of Medicine,Boston, MA, USA
Introduction: Laparoscopic cholecystectomy (LC) is one of the most commonly performed general surgical procedures. Despite its frequency, several cases are riddled with intraoperative complications. We have previously identified preoperative clinical features that help predict a complicated LC (CLC). With this project, we aim to identify radiographic features that may also help predict these CLCs.
Methods: A total of 750 consecutive cholecystectomies that took place over a 40-month period at a tertiary academic urban institution were reviewed. Outcomes of interest included Operative Time (OT) and a CLC (conversion to open, partial cholecystectomy, need for surgical drainage). Patient demographics, clinical and radiographic features, surgeon characteristics and operative outcomes were analyzed. Regression models were fitted for our outcomes of interest. Statistical significance was declared at p<0.05.
Results: Ninety eight percent of our sample underwent a preoperative ultrasound (US), and 20.7% computed tomography. The average age was 44.6 years (IQR 42, 57), Charlson comorbidity index 1.71±2.1, and males comprised 27.5% of our sample. OT averaged 72 min (IQR 63, 82), and the incidence of CLC was 15.1%. Hospital LOS was 3±3.6 days. Gallbladder wall thickness on US was associated with CLC [OR 1.26 (95%CI 1.10-1.45), p=0.001], as was presence of pericholecystic fluid [OR 2.00 (95%CI 1.23-3.26), p=0.005]. US gallbladder wall thickness [OR 1.47 (95%CI 0.00-2.94), p=0.05] and pericholecystic fluid [OR 6.40 (1.90-10.89), p=0.005] were also associated with longer OT. The presence of sludge, gallbladder distention and number of stones were not associated with either outcome. The multivariable sonographic prediction of CLC is depicted on figure 1.
Conclusion: Knowledge of the above factors may alert surgeons to the possibility of a challenging cholecystectomy preoperatively.
