{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:22:09Z","timestamp":1787829729009,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Gall bladder wall thickness (GBWT) on ultrasonography is widely considered a predictor of operative difficulty in laparoscopic cholecystectomy; however, its independent predictive value remains to be fully established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and Methods:<\/jats:title>\n                    <jats:p>This prospective, observational study included 196 patients with symptomatic gallstone disease undergoing laparoscopic cholecystectomy at a tertiary care centre. Patients were stratified into four groups based on GBWT (\u22642 mm, 3\u20134 mm, 5\u20136 mm and &gt;6 mm). Operative outcomes, including adhesions, operative time, conversion to open surgery and post-operative complications, were analysed. Multivariate logistic regression identified independent predictors, and receiver operating characteristic (ROC) analysis determined the optimal GBWT cutoff.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Increasing GBWT was significantly associated with higher operative difficulty, including adhesions (16.4% vs. 40.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.023), longer operative time (52.4 vs. 68.2 min,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.002) and higher conversion rates (3.6% vs. 20.0%,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.045). On multivariate analysis, GBWT &gt;2 mm independently predicted adhesions (adjusted odds ratio [AOR]: 1.82, 95% confidence interval [CI]: 1.05\u20133.14), conversion (AOR: 2.41, 95% CI: 1.08\u20135.36) and drain placement (AOR: 2.06, 95% CI: 1.12\u20133.78). ROC analysis demonstrated moderate predictive accuracy (area under the curve 0.72), with an optimal cutoff of &gt;3 mm (sensitivity \u2013 68.5% and specificity \u2013 70.2%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>GBWT is an independent and clinically useful predictor of operative difficulty in laparoscopic cholecystectomy. Routine pre-operative ultrasonographic assessment can aid in risk stratification and surgical planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/jmas.jmas_264_26","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T11:01:18Z","timestamp":1787828478000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Pre-operative sonographic assessment of thick-walled gall bladder in gallstone disease and its influence on the operative outcomes in laparoscopic cholecystectomy"],"prefix":"10.4103","author":[{"family":"Kritika","sequence":"first","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deepak","family":"Pankaj","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nitesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sudhanshu","family":"Somvanshi","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prashant","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, 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