title: The degree of gallbladder wall thickness and its impact on outcomes after laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is the gold-standard procedure for management of symptomatic gallstone disease. Increased rates of conversion to an open procedure, increased postoperative complications, and longer lengths of stay are seen in thick-walled gallbladders. Previous studies have only evaluated gallbladder walls as being thick or not thick, without looking at the degree of thickness. We hypothesized that, the more severe the wall thickening, the greater the chance of conversions and complications, and the longer the lengths of stay.
  
  
  METHODS
  All attempted laparoscopic cholecystectomies in our institution between 2006 and 2009 were retrospectively reviewed. Patients undergoing cholecystectomy for reasons other than gallstones (e.g., polyps or cancer) and those without preoperative ultrasounds were excluded. Patients were divided into four groups based on the degree of gallbladder wall thickness: normal (1-2 mm), mildly thickened (3-4 mm), moderately thickened (5-6 mm), and severely thickened (7 mm and above). Outcomes were compared amongst the groups.
  
  
  RESULTS
  874 patients were included in the study. There were 68 conversions (7.8 %) and 58 complications (6.6 %). The incidence of conversions was 3.1, 5.1, 14.9, and 16.8 % in the four groups, respectively (p < 0.001, χ (2)), and the incidence of complications was 1.8, 6.7, 9.1, and 13.1 %, respectively (p = 0.001, χ (2)). The mean (± standard deviation, SD) length of stay in days was 1.09 ± 1.42, 1.83 ± 3.24, 2.54 ± 3.40 and 3.54 ± 4.61, respectively [p < 0.001, analysis of variance (ANOVA)].
  
  
  CONCLUSIONS
  A greater degree of gallbladder wall thickness is associated with an increased risk of conversion, increased postoperative complications, and longer lengths of stay. Classifying patients according to degree of gallbladder wall thickness gives more accurate assessment of the risk of surgery, as well as potential outcomes.
authors.affiliation: Department of Surgery, Bronx-Lebanon Hospital Center, 1650 Selwyn Avenue, Suite 4E, Bronx, NY 10457, USA.
authors.forename: Shankar R
authors.initials: SR
authors.lastname: Raman
authors.forename: Dovid
authors.initials: D
authors.lastname: Moradi
authors.forename: Bassem M
authors.initials: BM
authors.lastname: Samaan
authors.forename: Umar S
authors.initials: US
authors.lastname: Chaudhry
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: John Morgan
authors.initials: JM
authors.lastname: Cosgrove
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Farkas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D005704:Gallbladder / Q000473:pathology*; D042882:Gallstones / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult