Diagnostic Accuracy of Preoperative Ultrasonography for the Predictor of Difficult Laparoscopic Cholecystectomy in Patients Undergoing It for Symptomatic Cholelithiasis at Tertiary Care Hospital Karachi

Objective: To determine the diagnostic accuracy of preoperative ultrasonography for the prediction of difficult laparoscopic cholecystectomy in patients undergoing it for symptomatic cholelithiasis at Tertiary Care Hospital, Karachi. Study Design and Setting : Cross-section validation study. The study was conducted at the Department of Surgery, JPMC, Karachi over a period of six months after approval of the synopsis (08-02-21 till 08-08-21). Methodology : After obtaining verbal consent, patients' data were prospectively collected. 230 patients fulfilled the diagnostic requirements. Frequency and percentages were used to represent qualitative variables, whereas mean and standard deviation were the only descriptive statistics used to convey quantitative data. Calculations were made for sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. Results : A total of 230 patients were included in this study. Mean age, duration of surgery, height, weight, and BMI in our study were 42.23±8.57 years, 1.41±0.40 hours, 165.62±8.23 cm, 68.34±8.23 kg and 24.85±3.34 kg/m2 respectively. 124 (53.9%) were male and 106 (46.1%) were female. Sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of preoperative ultrasonography for the prediction of difficult laparoscopic cholecystectomy by taking intraoperative findings as the gold standard was found to be 88.2%, 85.8%, 91.4%, 81.1%, and 87.3% respectively. Conclusion: Preoperative ultrasonography is a good indicator of the difficulty of a laparoscopic cholecystectomy in most situations, thereby it should be utilized as a screening tool. It can assist the surgeon in developing an understanding of the challenges that he might encounter with a certain patient.