STUDY TO ASSES DIFFICULT LAPAROSCOPIC CHOLECYTECTOMY IN PREOPERATIVELY SONOLOGICALLY PROVED CONTRACTED VS DISTENDED GALL BLADDER

Dr. Ramesh Kaundal, Dr. Vishal Thakur and Dr. Seema*

ABSTRACT

Background: Laparoscopic cholecystectomy is a revolutionary change in the treatment of patients with gallbladder stones. Cholelithiasis is a common problem in day to day surgical practice, which has a prevalence of 10-15%.In laparoscopic cholecystectomy there are many factors which can lead to laparoscopic cholecystectomy more difficult than it appears and dreaded complication of laparoscopic cholecystectomy is bile duct injury. Out of many predictors, contracted gall bladder on preoperative sonogram can predict a difficult cholecystectomy. In this study we will asses preoperative ulatrasound proven contracted gall bladder for difficult cholycystectomy. To identify contracted gall bladder preoperatively ultrasonologically can be helpful for the surgeon to make safe laparoscopic cholecystectomy. Methods: A prospective study was carried out at IGMC Shimla, himachal Pradesh from july 2018tpo aug 2019. One hundred patients with symptomatic cholelithiasis were taken up for the study after due clearance from the institutional ethical committee. Preoperative ultrasound abdomen was performed to rule out gall bladder status wether it was contracted or distended and intraoperative difiiculties were compared in a case of contracted gall bladder to distended gall bladder. Results: Ultrasonologically proven contracted gall bladder were associated with difficult laparoscopic cholecystectomy. Conclusions: Contracted gall bladder were significantly associated with difficult cholecystectomy.preoperative identification of contracted Gall bladder can be a significant predictor for difficult cholecystectomy and will help the surgeon extra cautious during the procedure so as to minimize the complications.

Keywords: Difficult laparoscopic cholecystectomy, Contracted Gall bladder, Preoperative Ultrasound Abdomen.