Grading Operative Findings At Laparoscopic Cholecystectomy A Scoring System in Grh, Madurai
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 12
Abstract
Aim And Objective: Laparoscopic cholecystectomy has become the gold standard in the treatment of gallbladder pathology and is replacing open cholecystectomy. To study the scoring system of operative findings at laparoscopic cholecystectomy, to allow grading of the findings and standardize the degree of cholecystitis. Methods: 50 patients who underwent Laparoscopic cholecystectomy for a period of 6 months were included in the study. The current scoring system proposed is based on the severity of cholecystitis and degree of potential difficulty with a score from 1 to 10. The key aspects of the score include access to the gallbladder including patient body mass index (BMI), the degree of pericholic and right upper quadrant adhesions particularly in patients who have had previous abdominal surgery, the presence of complicated cholecystitis and the time taken by the surgeon to achieve the triangle of safety with identification of the cystic artery and duct.With this scoring system a score of <2 would be considered easy, 2 to 4 moderate, 5–7 very difficult, and 8 to 10, extreme. Results: In the present study the patients were selected from age 20 and above. The youngest age was 23 years and the oldest patient aged 84 years. most number of patients were above 50 years of age. Out of 50 patients , 25 were male and 25 were female patients. The male to female ratio in this study is 1: 1. 12 patients had no adhesions over gall bladder, 10 patients had < 50% adhesions, 21 patients had >50% adhesions and 7 patients had the entire gallbladder buried under the omental adhesions. 47(94%) patients had distended gall bladder and 3(6%) patients had contracted gallbladder. 42(84%) patients in whom the gallbladder was able to grasp with the atraumatic forceps and in 8(6%) patients the gallbladder was not able grasp with the atraumatic forceps. 4(8%) patients had impacted stone in the Hartmann’s pouch and remaining 46(92%) patients had no stones impacted in the Hartmann’s pouc6(12%) patients who had adhesions from previous surgeries limiting the access to the gallbladder and calots triangle .Remaining 44(88%) patients had no such adhesions. h. 29(58%) patients had BMI of <30 and 21(42%) patients had BMI of >30. 7(14%) patients had pus leak from the gallbladder intraoperatively. Remaining 43(86%) patients had no such pus leakage from the gallbladder during the procedure. , the time taken to dissect the cystic artery took less than 90 min in 46(92%) patients . In remaining 4(8%) patients the dissection took morre than 90 minutes. 10 patients had mild difficulty, 25 patients had moderate difficulty , 12 patients had severe difficulty and 3 patients had extreme difficulty. These 3 patients were converted for open cholecystectomy. 47(94%) patients were proceeded with laparoscopic cholecystectomy who were categorized into mild , moderate and severe grades. The 3(6%) patients with extreme grade were converted from laparoscopic to open cholecystectomy Conclusion: this study has identified certain intraoperative variables to assess the difficulty of laparoscopic cholecystectomy in our setting. This study demonstrates that a scoring system predicting the difficulty in LC is feasible
Authors and Affiliations
Dr. A. M. Syed Ibrahim, Dr. P. Manivannan
Keywords
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- EP ID EP250436
- DOI 10.9790/0853.1612013443
- Views 67
- Downloads 0
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