1Post Graduate, Deemed SRM Medical College and Hospital, Dept of General Surgery, MS General Surgery Postgraduate. Email ID: shankar15soniya@gmail.com. Orcid ID: 0009-0001-4634-5996
2Assistant Professor, Deemed SRM Medical College and Hospital, Dept of General Surgery, MS General Surgery. Email ID: tilakramu@gmail.com. Orcid ID: 0000-0002-5167-5555
3Senior Resident, Deemed Saveetha Medical College and Hospital, Dept of General Surgery, MS General Surgery. Email ID: sharudhev@gmail.com. Orcid ID: 0009-0004-6548-3397
4*Professor, Deemed SRM Medical College and Hospital, Dept of General Surgery, MS General Surgery. Email ID: trace.balaji@gmail.com. Orcid ID: 0009-0000-0001-9654-0500
Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstone disease; however, a subset of patients experiences significant intraoperative difficulty, leading to complications or conversion to open cholecystectomy. Accurate preoperative prediction of difficult LC remains challenging. Ultrasonography, being widely available and non-invasive, offers potential predictive value when structured into a standardized scoring system.
Methods: This prospective observational study was conducted in a tertiary care teaching hospital over 12 months and included 50 adult patients undergoing elective laparoscopic cholecystectomy for ultrasonography-proven cholelithiasis or cholecystitis. Seven ultrasonographic parameters were assessed preoperatively and scored to generate a composite ultrasound score. A score ≤5 predicted easy LC, while a score >5 predicted difficult LC. Intraoperative difficulty was assessed using predefined surgical criteria. Diagnostic performance of the scoring system was analyzed.
Results: Seventeen patients (34%) were predicted to have difficult LC preoperatively, while 16 cases (32%) were classified as difficult intraoperatively. A strong correlation was observed between higher ultrasound scores and intraoperative difficulty. The scoring system demonstrated a sensitivity of 81.3%, specificity of 88.2%, and overall diagnostic accuracy of 86%. Gallbladder wall thickness >4 mm, distended gallbladder, impacted stones, and dilated common bile duct were significantly associated with difficult LC (p < 0.05).
Conclusion: The ultrasound-based scoring system is a reliable and practical tool for preoperative prediction of difficult laparoscopic cholecystectomy and can aid in surgical planning and patient counselling.
Keywords: Laparoscopic cholecystectomy; Ultrasound scoring system; Difficult cholecystectomy; Preoperative prediction; Gallstone disease
How to cite this article: Soniya SK, Tilak Ramu G, Sharandhev RS, Balaji. A Prospective Observational Study to Evaluate Preoperative Prediction of Difficult Laparoscopic Cholecystectomy Using Ultrasound Scoring System. Int J Drug Deliv Technol. 2026;16(13s): 837-841. DOI: 10.25258/ijddt.16.13s.91.
Source of support: Nil.
Conflict of interest: None