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AJR 2000; 174:1433-1439
© American Roentgen Ray Society

Sonography for Selecting Candidates for Laparoscopic Cholecystectomy

A Prospective Study

Hans-Peter Dinkel1,2, Simon Kraus1, Johannes Heimbucher3, Roland Moll1, Joachim Knüpffer1, Heinz-Jochen Gassel3, Stefan M. Freys3, Karl-Hermann Fuchs3 and Gerhard Schindler1

1 Department of Diagnostic Radiology. University of Würzburg, Luitpoldkrankenhaus, Josef-Schneiderstr. 2, D-97080 Würzburg, Germany
2 Present address: Institut für Diagnostische Radiologie, Inselspital, Universität Bern, Freiburgstr. 20, CH-3010 Bern, Switzerland.
3 Department of Surgery, University of Würzburg, D-97080 Würzburg, Germany.

OBJECTIVE. We assessed the value of sonography in predicting intraoperative difficulties for patients undergoing laparoscopic cholecystectomy and in identifying indicators for conversion to conventional cholecystectomy.

SUBJECTS AND METHODS. Upper abdominal sonography was performed (according to a checklist) in 75 consecutive patients before laparoscopic cholecystectomy. Sonographic findings were verified by the surgeon in the operating room.

RESULTS. Conversion from laparoscopic surgery to laparotomy was performed in five patients (6.7%). Of 75 patients, 19 had sonograms revealing gallbladder wall thickening (>4 mm); surgical preparation difficulties in 16 of these patients led to laparotomy in four patients. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of technical difficulties were 66.7%, 94.1%, 84.2%, and 85.3%, respectively. Sensitivity, specificity, positive predictive value, and accuracy of wall thickening as an indicator of surgical conversion were 80.0%, 78.6%, 21.1%, and 78.7%, respectively. Technical difficulties at laparoscopy occurred in all five patients with pericholecystic fluid on sonography (sensitivity, 20.8%; specificity, 100%; positive predictive value, 100%; accuracy, 74.7%) and led to laparotomy in three patients (sensitivity 60.0%, specificity 97.1%, positive predictive value 60%, accuracy 94.7%). The accuracy of sonography for cholecystolithiasis was 100%.

CONCLUSION. On sonography, gallbladder wall thickening is the most sensitive indicator and pericholecystic fluid is the most specific indicator of technical difficulties during laparoscopic cholecystectomy. Such difficulties may require conversion to laparotomy.


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