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Laparoscopic cholecystectomy(LC): predictive role of preoperative ultrasound

Metodi, tecniche, farmaci, 101 - 104
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Abstract
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English version
Aim: we studied several ultrasounds patterns concerning gallbladder, biliary tract and gallstones to identify some predictive signs of difficulties during LC.
Patients & methods: 112 patients (24 females), 25-75 years old, upper abdomen operated patients not included. From 7 ultrasounds patterns 4 degrees of potential intra-operative difficulty (0-3) were obtained. During the operation 7 conditions of true intra-operative problems were also classified.
Results: patients showing grade 0 : regular gallbladder wall, stones < 20 mm, regular Main Biliary Tract (MBT)= 62 LC and 2 open surgery conversion (OSC); grade 1: wall < 4 mm, stones > 20 mm= 24 LC and 7 OSC; grade 2: hydrops, wall > 4 mm, infundibolar stone = 6 LC and 6 OSC; grade 3: wall > 4 mm, stones > 20 mm, empyema of gallbladder, MBT ? 6 mm = 3 LC and 0 OSC.
Flogosis near gallbladder and wall > 4 mm were mainly responsible for transition of LC in OSC.
Conclusion: several predictive conditions for intraoperative difficulties are often detectable by accurate preoperative ultrasounds examination, with the aim of best surgical planning and to select those patients to entrust to surgeons during their learning phase.

Versione Italiana
Scopo: abbiamo esaminato diversi quadri ecografici onde predire difficoltà chirurgiche della videolaparocolecistectomia (VLC).
Pazienti e metodi: 112 pazienti (24 donne, 27-75 anni) esclusi quelli operati all?addome inferiore. Combinando 7 aspetti ecografici abbiamo stilato 4 gradi di potenziale difficoltà e condizioni.
Risultati: grado zero se parete regolare e calcoli <20 mm e via biliare principale inalterata (62 VLC e 2 open); grado 1 con parete colecisti < 4 mm e calcolo > 20 mm (24 VLC e 7 open); grado 2: idrope con parete > 4 mm e con calcolo infundibolare (6 VLC e 6 conversioni open); grado 3: parete >4 mm, calcolo > 20 mm, empiema, via biliare da 6 mm in su (3 VLC). I maggiori responsabili di conversione ?open? sonos stati : la flogosi pericolecistica e l?ispessimento della parete maggiore di 4 mm.
Conclusioni: un?accurata ecografia preoperatoria può rilevare diverse condizioni di difficoltà intraoperatorie allo scopo di una migliore pianificazione del tipo di intervento e anche per selezionare quei pazienti da affidare ai chirurghi in formazione.

Vol XL (No. 4) 2019 July-August

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