Análise cirúrgica transoperatória e ultrassonográfica pré-operatória na Colecistectomia Laparoscópica eletiva em pacientes com Colelitíase

Abstract

Introduction Laparoscopic cholecystectomy surgery is widely used for cholelithiasis. Abdominal ultrasound often precedes this surgery and can prove the diagnosis, as well as evidence possible complications during the perioperative period. This study aims to evaluate the description of variables of the gallbladder and bile ducts present in the reports of preoperative abdominal ultrasonography in cholelithiasis and to compare sonographic and surgical findings. Materials and Methods 91 patients who underwent elective laparoscopic cholecystectomy in IMIP Surgery Service, in Recife, from August 2014 to May 2015, with previous abdominal ultrasonography were evaluated. Description rates of ultrasound parameters were calculated. Variables such as the identification and the amount of gallstones involved were evaluated, both in the preoperative ultrasound and during surgery to evaluate the sensitivity, specificity, concordance and positive and negative predictive values of USG as to each one of the isolated parameters. Results: In the analysis of the rates of variable description of gallbladder in the reports, among the ones that may predict difficulties that may occur and / or the surgical conversion, the diameter of the blister light was not measured in 98.9% of cases, distention of the organ was discarded in 62.6%, as it happened with the approximated size of the stones (58.2%), gallbladder wall thickening (41.8%) and evaluation of the common bile duct (39.6% of cases). It was found in this sample that the ultrasound had high values for sensitivity, concordance and positive predictive value for identifying the presence / absence of gallstones; 98.8%, 96.7% and 97.8% respectively. As the amount of gallstones (single or multiple), ultrasonography had concordance, negative predictive value and specificity of 82.75%, 89.06% and 87.69, respectively, with lower values for sensitivity (68.18%) and positive predictive value (65.21%) for that same variable. Conclusion The ultrasound reports fail in their lack of standardization. A significant percentage of the reports do not have variables that can predict preoperative complications and surgical conversion. The abdominal ultrasonography showed, in the analysed sample, high values of concordance, sensitivity and positive predictive value for detecting the presence of gallstones. Although the identification of the amount of gallstones did not show high values of sensitivity and positive predictive value.