Publication:

A study of preoperative factors predicting a difficult laparoscopic cholecystectomy

Background Laparoscopic cholecystectomy is considered the gold standard treatment for most gallbladder diseases. It has now become one of the most common operations performed by general surgeons. At times, it is difficult and takes longer time or some complications may occur or has to be converted in to open cholecystectomy. This study is undertaken to determine predictive factors for difficult laparoscopic cholecystectomy.  The aim of the study was to study pre-operative factors in the patients to predict whether the laparoscopic cholecystectomy will be easy or difficult. And to co-relate the pre-operative factors predicting a difficult Laparoscopic Cholecystectomy with intra-operative findings.

Methods This prospective study was carried out in the Department of General Surgery in IGGMC, Nagpur, Maharashtra, India over a period of 2.5 years. Total 52 patients were included in the study. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. A chi-square test has been used to find the significant association of findings of the preoperative score with postoperative outcome.

Results History of hospitalization for gall stone diseases, ultrasound abdomen showing gall bladder wall thickness >4 mm, presence of pericholecystic collection, and impacted stone can be considered as individual significant positive predictive factors to predict a difficult laparoscopic cholecystectomy preoperatively. While age >50 years, gender, BMI >25 kg/m2, and history of supraumbilical surgery/scar can’t be considered as an individual positive predictive factor.

Conclusions A uniform scoring system needs to be assessed and thoroughly evaluated by combining all these factors to predict a difficult laparoscopic cholecystectomy.