Association of preoperative ultrasonography findings with intraoperative surgical findings in patients undergoing laparoscopic cholecystectomy for gall stone disease

INTRODUCTION Gallstone disease is a common cause of hospital admission worldwide, including in Nepal. While many cases are asymptomatic, some develop complications requiring surgery. Laparoscopic cholecystectomy is the standard treatment. Ultrasonography is the main diagnostic tool, but discrepancies with intraoperative findings may occur. This study evaluated its ability to predict operative findings. MATERIAL AND

Methods

An analytical cross-sectional study was conducted over six months in the Department of General Surgery at Universal College of Medical Sciences and Teaching Hospital, Bhairahawa, Nepal. Although the minimum sample size was 93, a total of 150 patients with symptomatic cholelithiasis undergoing laparoscopic cholecystectomy were included. Data were analyzed using Microsoft Excel and SPSS version 20. Continuous variables were expressed as mean ± standard deviation and categorical variables as frequency and percentage. Chi-square and concordance analysis were applied, with p< 0.05 was considered significant.

Results

Among 150 patients, 125 (83.3%) were females and 25 (16.7%) were males. The mean age was 45.44 ± 13.51 years, with most patients aged 41–60 years (47.3%). Preoperative USG showed a distended gallbladder in 49.3% and multiple stones in 54.7%, with the largest stone ≥1 cm in 72% of patients. Intraoperatively, the gallbladder appeared normal in 81.3% of cases, and multiple stones were found in 60.7%. Adhesions were present in 28.7% of patients, and conversion to open surgery occurred in 1.3%. Significant concordance was observed between USG and intraoperative findings for the number and size of stones (p<0.001), while gallbladder wall thickness and pericholecystic collection showed no significant association.

Conclusion

Preoperative ultrasonography predicts gallstone number and size but less accurately assesses gallbladder wall thickness and pericholecystic fluid; intraoperative evaluation remains essential.