PREOPERATIVE PREDICTORS OF A DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY
Journal Title: INTERNATIONAL JOURNAL OF PURE MEDICAL RESEARCH - Year 2018, Vol 3, Issue 6
Abstract
Background:Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge at times. Aim of present study was to nd out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods:All cases of gallstone disease undergoing LC at Government General Hospital,Guntur were studied over one year Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with difficult LC. The cases conrmed by USG were evaluated with the following risk factors: age>50yrs,male sex, BMI 25.1-27 and >27.5,prior surgery, prior hospital admission, palpable gall bladder, gall bladder thickening, impacted stone, pericholystitic collection. Each risk factor is given a score.The total score upto 5 predicted easy surgery, 6-10 difficult and >10 is very difficult surgery. Results: 85 patients were studied with age ranging from 21-65 years, maximum incidence (53%) being in 35-50 years. The time taken for LC increased signicantly with increasing age. 60% were females but gender status did not affect the difficulty. Pain in the past 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (more with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon's difficulty and impacted stone in gallbladder neck increased the conversion rate. The highest age incidence of cholelithiasis was in the 4th decade, and was more common in females. Pain abdomen was the most common symptom. BMI >27.5 (P<0.001), history of prior hospitalization (P<0.0008), palpable gallbladder (p<0.0364), impacted stone (P<0.0103) and pericholecystic collection (P<0.0471) were signicant predictors of difficult laparoscopic cholecystectomy. INTERPRETATION AND CONCLUSION The proposed scoring system had a positive prediction value for easy prediction of 94.7% and for difficult prediction of 100%.The conversion rate from laparoscopic cholecystectomy to open cholecystectomy was 3%.Certain factors that increase the difficulty of LC can be identied preoperatively and this knowledge should be used when planning LC.
Authors and Affiliations
Dr. Oleti Ravi Teja, Dr. Mamidala Harsha Deepthi, Dr. Sam Vivek Gudisay
Keywords
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