Correlation among ultrasonographic and videoscopic findings of the gallbladder: surgical difficulties and reasons for conversion during laparoscopic surgery.

Laparoscopic cholecystectomy is currently the standard procedure for chronic and acute cholecystitis. The purpose of this prospective study was to evaluate the preoperative ultrasound findings of the gallbladder and correlate those aspects with surgical videoscopic and histopathologic findings and the results concerning intraoperative complications and the conversion index to open surgery. Gallbladder findings were classified into three categories according to the gallbladder wall characteristics and the presence of visible lumen and stones. Simple chronic cholecystitis (type I) and acute cholecystitis, with gallbladder wall thickness <5 mm (type IIa) presented significantly lower intraoperative complications without conversion to open surgery. Scleroatrophic (type III) and acute cholecystitis with gallbladder wall thickness >5 mm (type IIB) presented significantly more surgical difficulties and a higher conversion rate to open surgery (p < 0.01). We postulate that this classification will be useful for surgeons in predicting potential problems in individual patients, at least at the initial laparoscopic cholecystectomy experience, and in advising patients of the potential risks of and conversion to open surgery.