Clinical Trial: Correlation Between Power Doppler and Intraoperative Findings of Chronic and Acute Cholecystitis

Study Status: Completed
Recruit Status: Completed
Study Type: Observational

Official Title: Correlation Between Preoperative Power Doppler Sonography and Intraoperative Findings - Postoperative Outcomes of Chronic and Acute Cholecystitis Patients: Prospective Cli

Brief Summary: 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.

Detailed Summary:

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,
Sponsor: Samsun Education and Research Hospital

Current Primary Outcome: Correlation between wall thickness-vascularity and adhesion grade [ Time Frame: Up to ten days ]

Correlation between gallbladder wall thickness - vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and intraoperative adhesion grade (as measured by gallbladder adhesion scoring scale) of chronic and acute cholecystitis patients.


Original Primary Outcome: Same as current

Current Secondary Outcome:

  • Correlation between vascularity and gallbladder perforation [ Time Frame: Up to ten days ]
    Correlation between gallbladder wall vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and intraoperative gallbladder perforation
  • Correlation between vascularity and convertion [ Time Frame: Up to ten days ]
    Correlation between gallbladder wall vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and convertion to open cholecystectomy
  • Correlation between vascularity and operation time [ Time Frame: Up to ten days ]
    Correlation between gallbladder wall vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and operation time
  • Correlation between vascularity and drain usage [ Time Frame: Up to ten days ]
    Correlation between gallbladder wall vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and drain usage
  • Correlation between vascularity and specimen [ Time Frame: Up to twenty days ]
    Correlation between gallbladder wall vascularity (as measured by quantative measurement scale of gallbladder wall vascularity) and pathologic assessment of specimen
  • Correlation between wall thickness and specimen [ Time Frame: Up to twenty days ]
    Correlation between gallbladder wall thickness and pathologic assessment of specimen


Original Secondary Outcome: Same as current

Information By: Samsun Education and Research Hospital

Dates:
Date Received: June 1, 2014
Date Started: January 2012
Date Completion:
Last Updated: June 3, 2014
Last Verified: June 2014