caa a22 4500 477036171 CHVBK 20180405111305.0 cr unu---uuuuu 170330e19961001xx s 000 0 eng 10.1007/s002689900147 doi (NATIONALLICENCE)springer-10.1007/s002689900147 Technical Difficulties and Complications during Laparoscopic Cholecystectomy: Predictive Use of Preoperative Ultrasonography [Elektronische Daten] [Roberto Santambrogio, Marco Montorsi, Paolo Bianchi, Enrico Opocher, Luca Schubert, Maurizio Verga, Luca Federico, Gianpaolo Spina] Abstract. The aim of this study was to evaluate ultrasound findings as predictors of potential operative difficulties and complications during laparoscopic cholecystectomy (LC). From October 1993 to June 1995 a total of 143 patients with symptomatic cholelithiasis (50 males, 93 females, mean age 49.5 ± 15 years) were evaluated by ultrasound (US) the day before LC. The US examination assessed six parameters: gallbladder (GB) volume, GB wall thickness, GB neck position, GB stone mobility, stone maximum size, and GB adhesions. On the basis of these US findings, a predictive judgment of technical difficulties was expressed by degree: easy, difficult, and very difficult. Altogether 101 patients presented with uncomplicated symptomatic cholelithiasis, and 42 had acute cholecystitis. The operation was predicted to be easy in 38% of cases, difficult in 49%, and very difficult in 13% with a good correlation with the surgeon's intraoperative judgment (: r = 0.66). A significant association was found between stone mobility ( r = 0.37), presence of adhesions ( r = 0.36), and the difficulty of the procedure. The predictive US evaluation was significantly correlated with some intraoperative technical steps [dissection of Calot's triangle ( r = 0.41), dissection of the gallbladder bed ( r = 0.41)], and intraoperative bleeding ( r = 0.27). Our results suggest that preoperative US is a useful screening test for patients undergoing LC, and it can help predict technical difficulties. On the other hand, a relevant number of cases still exist wherein the concordance between the preoperative US classification and the surgical findings is unsatisfactory. In this group the surgeon cannot safely rely on the US examination alone. 1996 by the Société Internationale de Chir, ugie Santambrogio Roberto Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut Montorsi Marco Istituto di Chirurgia Generale e Oncologia Chirurgica, Universita di Milano, via F. Sforza 35, Milan, Italy, IT aut Bianchi Paolo Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut Opocher Enrico Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut Schubert Luca Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut Verga Maurizio Chirurgia 2, Osp. Fatebenefratelli e Oftalmico, C.so Ponta Nuova 23, Milan, Italy, IT aut Federico Luca Chirurgia 2, Osp. Fatebenefratelli e Oftalmico, C.so Ponta Nuova 23, Milan, Italy, IT aut Spina Gianpaolo Chirurgia 1, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut https://doi.org/10.1007/s002689900147 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s002689900147 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Santambrogio Roberto Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut NATIONALLICENCE 700 1- Montorsi Marco Istituto di Chirurgia Generale e Oncologia Chirurgica, Universita di Milano, via F. Sforza 35, Milan, Italy, IT aut NATIONALLICENCE 700 1- Bianchi Paolo Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut NATIONALLICENCE 700 1- Opocher Enrico Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut NATIONALLICENCE 700 1- Schubert Luca Clinica Chirurgica VI, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut NATIONALLICENCE 700 1- Verga Maurizio Chirurgia 2, Osp. Fatebenefratelli e Oftalmico, C.so Ponta Nuova 23, Milan, Italy, IT aut NATIONALLICENCE 700 1- Federico Luca Chirurgia 2, Osp. Fatebenefratelli e Oftalmico, C.so Ponta Nuova 23, Milan, Italy, IT aut NATIONALLICENCE 700 1- Spina Gianpaolo Chirurgia 1, Istituto di Scienze Biomediche Ospedale San Paolo, via A. di Rudini 8, Milan, Italy, IT aut Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer