“Assessment of Intraoperative First Port Findings for Predicting Difficulty Levels during Laparoscopic Cholecystectomyby ICHBS Scoring System”
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2019, Vol 18, Issue 1
Abstract
CONTEXT Laparoscopic Cholecystectomy (LC) is the gold standard management for Gallstones disease. This is continuously evolving and this article is an attempt to assess the difficulty levels for LC in an objective manner and to introduce a part of a scoring system –“ICHBS Score” and accordingly proper recommendations for surgical technique to be adopted as per difficulty levels Ia, Ib, IIa, IIb, andIII for safe cholecystectomy. MATERIAL&METHODS The study was conducted from October 2016 to September 2018 ( n=192)to study “clinico-radio-pathological parameters that can predict intra-operative difficulty levels during laparoscopic cholecystectomy” in patient‟s admitted through surgery outpatient department / Emergency / transferred from other departments for gallstone disease in Subharti medical college, Meerut, UP, INDIA after taking clearance from Institutional Ethical Committee. All the patients were operated in a single tertiary care hospital.Patients satisfying the inclusion and exclusion criteria were included in the study and they underwent laparoscopic cholecystectomy and proposed ICHBS scoring system was applied to analyse and co-relate the pre-operative factors and intra operative first port findings to decide the operating difficulty level (Level Ia , Ib, IIa, IIb, III) during laparoscopic cholecystectomy for gall bladder disease and formulation of recommendations for surgical management of gall bladder disease according to operating difficulty level was done. STATISTICAL ANALYSIS USED Univariate statistical analysis was performed using Chi- Square test via SPSS 25.0 software. A correlation matrix was developed to evaluate co relation between individual parameters as well as intra operative first port laparoscopic findings with level of operative difficulty and its recommendations (ICHBS scoring system). RESULT We have found statistically highly significant correlation between preoperative and intraoperative predictive parameters with operative difficulty levels Ia , Ib, IIa, IIb and III and its surgical technique recommendations outcome with„p‟- value = 0.000. CONCLUSION The ICHBS scoring is a very reliable system for safe LC and statistically significant outcome for safe cholecystectomy was observed following recommendations as per difficulty levels (Ia, Ib, IIa, IIb and III) for managing the gall stones/ acalculouscholecystitispatients. According to the ICHBS scoring system( minimum=0; maximum=40), the difficulty levels for laparoscopic cholecystectomy can be assessed combining preoperative as well as intraoperative first port findings by using an objective score and appropriate operative recommendations for that difficulty level can be obtained and practiced for safe cholecystectomy.
Authors and Affiliations
Mishra Shashank, Garg Ankit, Tyagi Ruchi, Bansal Rani, Bajpai Prateek, Gupta Deepanshu, Arora Shitij, Dalal S. Arun, Deb Ritika
Keywords
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- EP ID EP431044
- DOI 10.9790/0853-1801044651.
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