Relationship between Gallbladder Wall Thickness and the Conversion Rate to Open Cholecystectomy

Background: The gold standard procedure for cholecystitis is laparoscopic cholecystectomy. The presence of a thickened GB wall has been recognized as a risk factor in the conversion of LC to OC. The goal of this study is to see if there is a link between gallbladder wall thickness and the rate of conversion to open cholecystectomy.

Patients and Methods: In this prospective study, we looked at (140) patients who had a laparoscopic cholecystectomy at Al-Kadhimiya teaching hospital in the last three years (January 2019 to January 2020) and noted the reasons for conversion to OC. The results of the statistical analysis were then used to identify parameters that were associated with a higher chance of conversion. Our unit’s practice on timing for cholecystectomy is general practices interval cholecystectomy for most of our patients. Patients who underwent emergency cholecystectomy were excluded from this study.

Results: In the current study 18 patients out of 140 patients with cholecystitis who underwent laparoscopic cholecystectomies were converted to open cholecystectomy which equals (13%), as well as The failure to identify the anatomy of the Calot's triangle, a common bile duct injury with bile leak and possibly haemorrhage, or equipment failure were all reasons for the conversion (lack of Co2 gas and poor light source). In the current study, the conversion rate was equal to 13% of the total number of our patients, which constitute 18 patients out of 140, also the highest rate of conversion was within those patients whose age group was more than 50 years old (the total number was 11 patients, 4 patients out of them underwent conversion to OC, which constitutes 36.4 %). Patients aged 20-50 years were in total 124, 14 out of them underwent conversion, which equals 11.3%, while those under 20 years passed smoothly without conversion. so, By ultrasonography, 77.8% of converted cases had gallbladder wall thickness greater than 4mm, while the remaining 22.2 percent of converted cases had wall thickness less than or equal to 4mm.

Conclusion: The significant risk factor for conversion to OC was gall bladder wall thickness >4 mm.