Assessment of risk factors for difficult surgery in laparoscopic cholecystectomy
Journal Title: MedPulse -International Medical Journal - Year 2017, Vol 4, Issue 2
Abstract
Background: Laparoscopic cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. Prediction of a difficult LC would allow the surgeon to discuss the likelihood of conversion with the patient and prepare the patient psychologically as well as planning their recovery and explaining their absence from work. This study aim to assess the preoperative factors for prediction of difficulty of LC and the possibility of conversion to open cholecystectomy before surgery using the clinical, pathological and ultrasonological criteria. Material and Methods: This study was carried out on 60 patients with symptomatic cholelithiasis, normal liver function tests and non-dilated bile ducts scheduled for LC. Age, sex, body mass index, previous abdominal surgery and past history of acute attack of cholecystitis of the patients were recorded. Apre-operative ultrasound was performed along with routine blood investigations. Results: Overall conversion rate was 3.3%. Univariate analysis showed that sex, fever at the time of attack, gall bladder wall thickness, pericholecystic collection on ultrasonography, raised liver function test and total leucocyte count were significant for conversion. Discussion: It is possible to predict the risk of conversion and patients can be informed preoperatively. Patients with a high preoperative factors for prediction of difficult LC may allow the surgeon to take an early decision to convert to OC when difficulty is encountered during dissection; this may shorten the duration of surgery and decrease the associated morbidity.
Authors and Affiliations
Vijay Kassa, Rajnish Jaiswal
Keywords
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