Evaluation of patients with signs and symptoms of
biliary tract disease usually includes ultrasound assessment of the gallbladder. Does measurement of the thickness of the gallbladder wall yield any significant information to the clinical surgeon? The records of all my patients undergoing
cholecystectomy since 1990 were reviewed. The entire series consists of 401 consecutive patients, in whom 388 procedures were completed laparoscopically, with 14 patients requiring conversion to an open
cholecystectomy. Each patient's preoperative evaluation included a gallbladder ultrasound, which included measurement of the diameter of the gallbladder wall. The entire series of
cholecystectomies was evaluated according to the ultrasound measured diameter of the gallbladder wall. A thin gallbladder wall was less than 3 mm in diameter. A thick gallbladder wall was 3 mm or greater in diameter. Of the 401 consecutive patients who underwent
cholecystectomy for symptomatic
gallbladder disease, 86 (21.5%) were removed laparoscopically for acalculous disease. Eleven per cent of patients with
acalculous cholecystitis had
acute cholecystitis and 89 per cent had chronic
cholecystitis. Every patient with either a thin or thick gallbladder wall with
acalculous cholecystitis had a successful
laparoscopic cholecystectomy. Three-hundred fifteen patients had a
laparoscopic cholecystectomy for calculous
cholecystitis. In patients with calculous
cholecystitis, 28.3 per cent had
acute cholecystitis and 71.7 per cent had chronic
cholecystitis. The gallbladder wall was found to be greater than 3 mm in 38 per cent of patients with acute calculous
cholecystitis and greater than 3 mm in 41 per cent of patients with chronic calculous
cholecystitis. One-hundred, forty-two patients, out of a series total of 401, had a gallbladder wall thickness greater than 3 mm by preoperative sonography and 14 of these patients (10%) required conversion to an open
cholecystectomy. A preoperative gallbladder ultrasound evaluation for symptomatic
cholecystitis, which documents a thick gallbladder wall (> or =3 mm) with
calculi, is a clinical warning for the laparoscopic surgeon of the potential for a difficult
laparoscopic cholecystectomy procedure which may require conversion to an open
cholecystectomy procedure.