DIAGNOSTIC ACCURACY OF ULTRASOUND IN DETECTING PERICHOLECYSTIC ADHESIONS IN CHOLELITHIASIS PATIENTS KEEPING PER-OPERATIVE FINDINGS AS THE GOLD STANDARD
DOI:
https://doi.org/10.69656/pjp.v20i2.1666Keywords:
cholelithiasis, pericholecystic adhesions, ultrasoundAbstract
Background: Laparoscopic cholecystectomy is a standard technique for surgical management of cholelithiasis. Dense pericholecystic adhesions pose a primary challenge during the procedure, underscoring the importance of their pre-surgical detection. While ultrasonography remains the gold standard tool for diagnosing cholelithiasis, there is limited data available regarding its diagnostic accuracy in detecting pericholecystic adhesions. This study aimed to assess the diagnostic precision of ultrasound in identifying pericholecystic adhesions. Methods: This study was carried out in the Radiology Department of DHQ Hospital, Narowal, spanning from Jul 2023, to Mar 2024. With a sample size of 138, all patients enrolled in the study underwent fasting abdominal ultrasound to identify the sonographic features of pericholecystic adhesions, including pericholecystic stranding, pericholecystic fluid/exudates, contracted gallbladder lumen, and loss of gall bladder wall/hepatic parenchyma interface. Operative findings were gathered from the Surgery Department for subsequent analysis. Results: Out of the total 138 patients, 53 (38.4%) patients were true positive, 16 (11.6%) were false positive, 49 (35.5%) were true negative and 20 (14.5%) were false negative. Ultrasonography had 72.6% sensitivity, 75.3% specificity, 76.8% positive predictive value, 71.0% negative predictive value, and 73.9% diagnostic accuracy in preoperative prediction of pericholecystic adhesions. Conclusions: Ultrasound remains an accessible and cost-effective imaging tool for identifying pericholecystic adhesions in patients with cholelithiasis. It is a valuable and reliable tool in aiding the selection of most suitable operative technique for cholecystectomy.
Pak J Physiol 2024;20(2):27-30
Downloads
References
Bhat SA, Gorsi BA, Peer JA. Pre-operative predictors of difficult laparoscopic cholecystectomy. Ann Romanian Soc Cell Biol 2020;24(2):2149–58.
Kurtulus I, Culcu OD, Degerli MS. Which is more effective: laparoscopic or open partial cholecystectomy? J Laparoendoscopic Adv Surg Tech 2022;32(5):476–84.
Warcha?owski ?, ?uszczki E, Bartosiewicz A, Dere? K, Warcha?owska M, Oleksy ?, et al. The analysis of risk factors in the conversion from laparoscopic to open cholecystectomy. Int J Environ Res Public Health 2020;17(20):7571.
Al-Hayali M. Gallbladder perforation during elective laparoscopic cholecystectomy incidence, risk factors and outcomes. Indian J Public Health Res Dev 2021;12(4):319–28.
Christina NM, Wijaya JH. A systematic review and meta-analysis of the impact of obesity on postoperative outcomes for patients undergoing laparoscopic cholecystectomy. Bali Med J 2023;12(1):946–53.
Riaz S, Khan NA, Khalique A, Ramzan R, Aziz MA. Validation of a Pre-existing scoring system for preoperative prediction of difficulty in laparoscopic cholecystectomy. Pak J Med Health Sci 2023;17(4):405–7.
Abdelhamid MS, Gharib AZ, Mohammed MA, Negida M. Anticipation of difficulty during laparoscopic cholecystectomy. Arch Surg Clin Res 2020;4:24–8.
Wani AM, Rastogi R, Pratap V, Joon P, Gupta Y. Role of ultrasonography (USG) in evaluation of pericholecystic adhesions in gallstone disease (GSD). Ann Int Med Dental Res 2017;3(4):28–33.
Nassar AHM, Hodson J, Ng HJ, Vohra RS, Katbeh T, et al. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc 2020;34(10):4549–61.
Chhaparia S, Dewangan KP, Geddam SR. Prediction of difficult laparoscopic cholecystectomy on the basis of preoperative ultrasonography assessment. Int Surg J 2024;11(1):75–87.
Joyce A, Snelling PJ, Elsayed T, Keijzers G. Point?of?care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review. Australas J Ultrasound Med 2023;27(1):26–41.
Goldfinger MH, Ridgway GR, Ferreira C, Langford CR, Cheng L, Kazimianec A, et al. Quantitative MRCP imaging: accuracy, repeatability, reproducibility, and cohort?derived normative ranges. J Magn Reson Imaging 2020;52(3):807–20.
Amin A, Haider MI, Aamir IS, Khan MS, Khalid Choudry U, Amir M, et al. Preoperative and operative risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy in Pakistan. Cureus 2019;11(8):e5446.
Carbotta G, Panebianco A, Laforgia R, Pascazio B, Balducci G, Bianchi FP, et al. A new clinical-ultrasound score to predict difficult videolaparocholecystectomies: A prospective study. Ann Med Surg 2018;35:59–63.
Kapoor A, Sidhu BS, Singh J, Brar N, Singh P, Kapur A. Adhesions detection and staging classification for preoperative assessment of difficult laparoscopic cholecystectomies: A prospective case–control study. J Med Ultrasound 2023;31(2):137–43.
Wang X, Yu W, Jiang G, Li H, Li S, Xie L, et al. Global epidemiology of gallstones in the 21st century: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2024;(Suppl):S1542–3565.
Parra-Landazury NM, Cordova-Gallardo J, Méndez-Sánchez N. Obesity and gallstones. Visc Med 2021;37(5):394–402.
Raheem M, Shah SA, Waqar SH. Accuracy of ultrasonography in predicting factors for difficult laparoscopic cholecystectomy: accuracy of ultrasonography in difficult laparoscopic cholecystectomy. J Aziz Fatima Med Dent Coll 2022;4(1):1–5.
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Pakistan Journal of Physiology, Pak J Physiol, PJP is FREE for research and academic purposes. It can be freely downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.
