Abstract / Summary
Gallbladder wall thickening on preoperative ultrasonography may reflect inflammation and fibrosis and may be associated with more difficult laparoscopic cholecystectomy. This study evaluated the association between ultrasonographic gallbladder wall thickness and operative duration, intraoperative outcomes, postoperative complications, and hospital stay. This single-center observational analytical study included patients undergoing laparoscopic cholecystectomy at a tertiary hospital. Gallbladder wall thickness was measured preoperatively by ultrasonography and postoperatively by histopathology. Operative duration, drain placement, true intraoperative adverse events, 30-day postoperative complications, and hospital stay were assessed. Multivariable linear, binary logistic, and ordinal logistic regression models were adjusted for age, sex, and body mass index. Receiver operating characteristic analysis was used to explore discriminatory performance for postoperative complications. A total of 180 patients were analyzed. Ultrasonographic and pathological wall-thickness measurements showed good statistical agreement (ICC 0.790, 95% CI 0.728–0.840, p < 0.001). Wall thickness correlated with operative duration (Spearman ρ = 0.482, p < 0.001). Each 1-mm increase was associated with a 3.59-minute longer operation (B = 3.59, 95% CI 2.64–4.55, p < 0.001), higher odds of drain placement (adjusted OR 1.93, 95% CI 1.54–2.41, p < 0.001), postoperative complications (adjusted OR 1.72, 95% CI 1.29–2.29, p < 0.001), and longer hospitalization (adjusted proportional OR 1.77, 95% CI 1.50–2.09, p < 0.001). The AUC for postoperative complications was 0.761 (95% CI 0.620–0.902, p = 0.001). The exploratory ≥ 3-mm threshold had 80.0% sensitivity and 62.4% specificity. Greater ultrasonographic gallbladder wall thickness was associated with less favorable perioperative outcomes in this single-center cohort. These findings should be considered exploratory because of the limited number of adverse events, residual confounding, operator dependence of ultrasonography, and lack of external validation. Wall thickness may contribute to multifactorial preoperative risk assessment but should not be considered a standalone validated predictor.