Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic
cholelithiasis. Several preoperative variables have been identified as risk factors that are helpful
in predicting the probability of conversion to laparotomy for safe and successful removal of the
This study aimed to look for the various sonographic findings and to make a predictive index for
patients who are candidates for laparoscopic cholecystectomy, operative difficulties and
conversion to open cholecystectomy.
This is a prospective study conducted in the Department of Surgery of Al-Mawani General
Hospital, Al-Mousawi Private Hospital in Basrah, Iraq, between May 2005 and October 2008.
Abdominal Sonography performed in 105 consecutive patients before laparoscopic
cholecystectomy (the sonographic signs are: gallbladder wall thickness, pericholecystic fluid,
sonographic Murphy's sign, shrunken gallbladder, number and size of gallstones). Patients
excluded are those with history of jaundice, abnormal liver function test, upper abdominal
surgery, co-morbid illnesses, extreme obesity, dilated intrahepatic or extrahepatic biliary ducts or
those with CBD stones.
The surgeon re-evaluates the results of ultrasound with the results obtained during surgery.
One hundred and five patients included in the study, 103 patients with gallstones, the other 2
patients having polyps. Ultrasound was accurate 100% in detecting gallstones and polyps, 99
patients (94.3%) have their cholecystectomies via the laparoscope, 75 patient (75.8%) from
them show easy procedure, while 24 patients (24.2%) suffered from difficulties.
Six patients (5.7%) needed conversion to open cholecystectomy to complete the operation
In conclusion, there are many sonographic signs that we can be depend on them to give us an
idea about the possibility of conversion to open cholecystectomy, the most specific one is
pericholecystic fluid. Secondly gallbladder wall thickness more than 3mm, thirdly, sonographic
Murphy's sign, fourthly, shrunken gallbladder, fifthly single gall stone. The other signs are of less
specificity like size and multiplicity of gall stones.