Correlation of Preoperative Ultrasonography Data with Intraoperative Findings in Cholelithiasis: A Clinical Informatics–Based Predictive Analysis

Abstract

Background: Cholelithiasis is one of the most common gastrointestinal disorders requiring surgical intervention worldwide. Laparoscopic cholecystectomy remains the gold-standard treatment for symptomatic gallstone disease due to reduced postoperative pain, shorter hospital stay, and faster recovery compared with open surgery. However, altered anatomy, inflammation, adhesions, or trouble recognizing tissues inside Calot's triangle may make surgery challenging. Gallstones are often diagnosed and gallbladder pathology is assessed with preoperative ultrasonography (USG). Gallbladder wall thickness, common bile duct diameter, gallbladder distension, and stone features are examples of structured ultrasonographic data that may indicate intraoperative difficulties. Objective: To evaluate the correlation between preoperative ultrasonographic findings and intraoperative observations in patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis. Methods: A retrospective observational study was conducted at MGM Medical College and Hospital, Navi Mumbai, from April to December 2025. Eighty-two patients diagnosed with symptomatic cholelithiasis who underwent laparoscopic cholecystectomy were included in the study. Preoperative ultrasonographic parameters including gallbladder wall thickness, gallbladder lumen characteristics, distension, common bile duct diameter, number and size of stones, presence of bile sludge, and pericholecystic collection were recorded. These imaging variables were compared with intraoperative findings such as stone characteristics, gallbladder inflammation, adhesions, and operative difficulty. Statistical analysis was performed using SPSS version 24. Sensitivity, specificity, and predictive values were calculated, with p < 0.05 considered statistically significant. Results: Ultrasonography demonstrated very high sensitivity (99%) for detection of gallstones. Sensitivity and specificity for predicting stone number were 65.2% and 88%, respectively. Gallbladder wall thickness ≥3 mm showed high sensitivity (92.6%) but low specificity (20.8%) for predicting intraoperative inflammation. Increased common bile duct diameter was associated with operative difficulty in several cases. Ultrasonographic signs of acute cholecystitis correlated with dense adhesions and distorted Calot’s triangle anatomy during surgery. Conclusion: Preoperative ultrasonography provides clinically useful predictive indicators for operative difficulty in laparoscopic cholecystectomy. Integration of structured imaging variables into surgical planning may improve preoperative risk stratification and operative preparedness..