ABSTRACT
To identify if gallbladder wall thickness is associated with technical difficulty during laparoscopic surgery and whether conversion to open cholecystectomy is more frequent in such patients. This prospective, non-randomized and descriptive study was conducted in Department of Surgery, Unit IV of Civil Hospital Karachi from December, 2010 to November 2012. Sixty four patients who underwent laparoscopic cholecystectomy were included. A fresh ultrasound was performed one day prior to surgery and gall bladder wall thickness of 3 mm was taken as predictor for difficult surgery. Various intraoperative parameters were recorded including total time taken, time taken to clear calots triangle and conversion to open cholecystectomy. Out of 64 patients, 4 [6.3%] were males and 60 [93.8%] were females. Age ranged from 22-65 years with a mean of 40.45 +/- 12.43 years. Gall bladder wall thickness ranged from 1-4.2 mm with a mean of 1.78 +/- 0.80 mm. Difficult laparoscopic cholecystectomy was encountered in 13 [20.3%]. In patients with difficult laparoscopic cholecystectomy the mean gallbladder wall thickness was 2.40 +/- 0.87 mm [p=0.001]. The mean age of patients with difficult surgery was 40.54 +/- 13.80 years. Mean operating time in patients with difficult laparoscopic cholecystectomy was 90.77 +/- 30.81 minutes as compared to 57.02 +/- 20.63 minutes in normal laparoscopic cholecystectomy [p<0.001] This study identifies and corroborates with the international literature that gallbladder wall thickness of 3 mm is associated with difficult cholecystectomy and higher rate of conversion to open cholecystectomy