Publication:

Use of scoring system to predict difficult laparoscopic cholecystectomy

Introduction Laparoscopic cholecystectomy is the gold standard for treatment of symptomatic cholelithiasis. Most of the time it is easy and safe. However, difficulties may occur at times leading to difficult dissection, prolong operative time, injury to artery, injury to duct, bile spillage and injuries to surrounding viscera and conversion to open. This study aims to predict difficult laparoscopic cholecystectomy using preoperative scoring system.

Methods This was a prospective observational analytical study conducted at Department of Surgery, Bir Hospital over a period of one year. One hundred thirteen patients undergoing elective laparoscopic cholecystectomy for symptomatic cholelithiasis were included. Before the surgery patients were scored according the preoperative model, and the intraoperative scoring was recorded during the surgery. Finally, the two scoring systems were compared.

Results Sensitivity and specificity of preoperative scoring according to Randhawa scoring was 57.6% and 87.5 % respectively with PPV and NPV of 65.5% and 83.3% respectively. Factors like history of acute cholecystitis (p<0.05), pericholecystic collection (p=0.025) were found to be statistically significant in predicting DLC. Area under ROC curve was 0.725.

Conclusion Preoperative scoring is a good test to predict difficult laparoscopic cholecystectomy which is statistically significant with Area Under ROC curve 0.725. Preoperative scoring has potential advantage in surgical planning and counselling for possible complications.