Prediction of Difficult Laparoscopic Cholecystectomy during the First Conversation with the Patient
Journal Title: Journal of Clinical and Diagnostic Research - Year 2018, Vol 12, Issue 10
Abstract
ABSTRACT Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard now for symptomatic cholelithiasis. Any unexpected turn of events intra-operatively has significant implications which get multiplied many fold due to high number of procedures. If degree of technical difficulty could be predicted before starting the procedure, concerned team can be better prepared and adverse outcomes can be potentially minimised or forestalled. Aim: To study clinical factors responsible for technically difficult laparoscopic cholecystectomy during the first visit of the patient to outdoor. Materials and Methods: This prospective analytical study, based on convenient sampling method, was used to select 125 patients sequentially, who underwent LC. Difficulty assessment was done by a Likert type questionnaire. Weighted Difficulty Score (WDS) was calculated and compared against pre-operative parameters. Results: Difficulty of doing surgery increased with age, history of diabetes mellitus and hypertension and obesity. No difference was found in difficulty score for gender and previous history of surgery. Recurrent cholecystitis, prior-hospitalisation, length of hospital-stay and duration since first episode predicted a difficult LC but not duration since last episode. Icterus and palpable gall bladder were also found to increase the difficulty but presence of tenderness and Murphy’s sign had no relation with the difficulty score. Conclusion: Our results demonstrate that difficult LC can be predicted based on parameters on history and physical examination alone at the first visit of the patient to OPD. Both the patient and surgical team can, therefore, be better prepared for the possible complications and conversions in an environment of confidence and mutual trust.
Authors and Affiliations
Kumar Nishant, Varun Kumar Singh, Phuchungla Bhutia, Bikram Kharga, Barun Kumar Sharma, Nitin Jain
Keywords
Related Articles
- EP ID EP529139
- DOI 10.7860/JCDR/2018/28496.12089
- Views 73
- Downloads 0
Association of Serum Free Haemoglobin in Normoglycemic and Hyperglycemic Individuals
ABSTRACT Introduction: Besides glycation induced injury, hyperglycemia in both type 1 and 2 diabetes can also increase oxidative stress leading to alterations in erythrocytic structural-functional organisation, shortenin...
Deep Cerebral Vein Thrombosis: A Clinical Masquerader
Cerebral Vein Thrombosis (CVT) is an uncommon cause of stroke. Thrombosis can occur in superficial veins, deep venous system or cortical veins of brain. The term Deep Cerebral Vein Thrombosis (DCVT) is used for thrombosi...
Esthesioneuroblastoma Presenting with Bilateral Proptosis and Blindness in a Child: A Case Report
Esthesioneuroblastoma is a rare malignant tumour of the olfactory epithelium. The most common symptom is related to unilateral nasal obstruction. It rarely presents with bilateral proptosis and blindness. We report a 21-...
Lesinurad, a Novel Uricosuric Drug for Allopurinol-Refractory Gout Patients
ABSTRACT Gout is the most common type of arthritis in developed countries that is often inadequately managed. Evidence regarding role of hyperuricaemia in poor outcomes in gout patients (e.g., disability, recurrent hosp...
Periapical Cemento-Osseous Dysplasia in Anterior Maxilla
ABSTRACT Periapical cemento-osseous dysplasia is a reactional fibro-osseous lesion that affects the supporting tissues of vital teeth. A 33-year-old female was referred for endodontic retreatment of the right maxillary c...