Acute Cholecystitis With Chronic Cholecystitis Clinical Trial
Official title:
Correlation Between Preoperative Power Doppler Sonography and Intraoperative Findings - Postoperative Outcomes of Chronic and Acute Cholecystitis Patients: Prospective Clinical Study
In theory, increased vascularity of GB wall could be associated with intraoperative findings, such as, GB wall inflammation and accompanying adhesions. There are not enough reports in the literature describing the correlation between GB wall vascularity and operative findings according to adhesion scoring scale. In this prospective clinical study, we aimed to highlight the correlation between preoperative power Doppler sonography detected GB wall vascularity and intraoperative findings - postoperative outcomes of chronic and acute cholecystitis patients.
Gray-scale sonography is generally considered as a first-line diagnostic tool for patients
with suspected gallbladder (GB) diseases. Once the gallstone is detected in a patient who is
complaining abdominal pain in the right upper quadrant, the second concern is to
differential diagnosis, biliary colic or acute cholecystitis. Certain diagnosis of acute
cholecystitis is important, because of these two entity require different treatments.
Gray-scale sonography has proven to be a valuable imaging technique in differential
diagnosis for acute or chronic cholecystitis (1). In the presence of gallstones, sonographic
findings such as GB wall thickening and the Murphy's sign has 90% sensitivity for the
diagnosis of acute cholecystitis (2). On the other hand, abdominal pain and accompanying GB
wall thickening can be seen in different clinical scenarios such as, pancreatitis,
hepatitis, cirrhosis, and congestive heart failure. Thus, the specificity of these
sonographic findings are not as high as their sensitivity. To eliminate this diagnostic
concern, the need for correlation between diagnostic tool and disease physiopathology was
realized. The GB wall is thickened and the vascularisation is increased in acute
cholecystitis, but in the chronic cholecystitis the thickening of the GB wall is caused by
fibrosis. This pathologic difference is to key point of distinguishing between acute and
chronic cholecystitis. Determining the vascularisation of the GB wall with Doppler
sonography was showed valuable diagnostic benefits, and the diagnostic superiority was
obtained especially with power Doppler sonography (3).
Today, laparoscopic cholecystectomy (LC) has become the gold standard treatment for benign
biliary diseases. Although, the laparoscopic approach to acute cholecystitis have a lot of
advantages, such as; less postoperative pain, shorter hospital stay and better cosmetic
results, timing of the operation and intraoperative findings of GB wall inflammation and
adhesions are critical for performing a safe cholecystectomy. The risk of bleeding and bile
duct injury are significantly increases in the presence of severe inflammation and adhesions
(4). These findings may lead surgeon to convert LC to an open cholecystectomy.
In theory, increased vascularity of GB wall could be associated with intraoperative
findings, such as, GB wall inflammation and accompanying adhesions. There are not enough
reports in the literature describing the correlation between GB wall vascularity and
operative findings according to adhesion scoring scale. In this prospective clinical study,
we aimed to highlight the correlation between preoperative power Doppler sonography detected
GB wall vascularity and intraoperative findings - postoperative outcomes of chronic and
acute cholecystitis patients.
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Observational Model: Case Control, Time Perspective: Prospective