Evaluation of preoperative predictive factors that determine difficult laparoscopic cholecystectomy

Abstract

The advantages of laparoscopic cholecystectomy over open cholecystectomy are earlier return to bowel functions, less postoperative pain, better cosmetic outcome, shorter length of hospital stay, earlier return to full activity, and decreased overall cost. Laparoscopic cholecystectomy is associated with better preservation of ABSTRACT Background: Cholelithiasis is the most common biliary pathology. Gallstones are present in 10 to 15% of the general population and asymptomatic in the majority (>80%). The prevalence of gallstone varies widely in different parts of the world. In India it is estimated to be around 4%. Since laparoscopic cholecystectomy is the most common procedure done now days we undertook a study to evaluate factors determining difficult laparoscopic cholecystectomy. The objective of the study was to evaluate preoperative data that can serve as predictors of difficult laparoscopic cholecystectomy and help in planning of surgery. Methods: Patients presenting with upper abdominal discomfort and sonographically confirmed cholelithisis were studied in terms of several clinical factors and scoring system was devised. Based on scoring system patients were categorised and evaluated post operatively. Results: In present study prior history of hospitalisation (p<0.001), previous abdominal surgeries (p<0.01), palpable gall bladder (p<0.01), BMI >27.5 (p<0.01), thickened GB wall (p<0.001) were found to be significant predictors of difficult laparoscopic cholecystectomy. Remaining parameters like age, sex, impacted stone and pericholecystic collection were not found significant predictors of difficult laparoscopic cholecystectomy. Conclusions: Difficult laparoscopic cholecystectomy can be predicted preoperatively based on parameters used in the study. Knowledge of these factors for difficult laparoscopic cholecystectomy could help surgeons during preoperative assessment and improve the informed consent.

Prediction of difficult laparoscopic cholecystectomy on the basis of preoperative ultrasonography assessment

“…Patil et al studied on 50 patients and found impacted stone was not a significant criterion for difficult LC (p>0.3). 7 Suryawanshi et al (600 patients) reported that this was a significant criterion. 32 Siddiqui et al studied on 300 patients and also found presence of impacted stone was significant (p<0.05).…”

"Morbidity and Mortality of Open and Laparoscopic Cholecystectomy in Males. Multicenter Study"

“…Variables such as age, sex, and impacted stones were not found to be significant predictors. However, they mention that in the case of men they may outperform women, due to sociocultural factors that predispose a late attendance to medical centers [35]. In addition, Chávez Segura stated the results of studies in relation to sex should be considered inconclusive, because most of the population that goes to hospitals are mostly female [36], which we take as a reservation because it is more frequent in women.…”

“…In relation to sex, Shreenath et al do not consider it as a predictor, but report that conversion secondary to difficult cholecys-tectomy is frequent in patients with history of hospitalization, previous abdominal surgeries, palpable gallbladder, BMI greater than 27.5 kg/m2 and thickened gallbladder wall. Sex, age, and impact calculation were not identified as predictors [14,15]. In summary, the prevalence of cholelithiasis in Mexico is 14.3%, of which 8.5% are men and 20.5% are women; obesity has been reported to be associated with a cholelithiasis elevated risk [16] and as an important factor in the conversion of LC [17,18].…”

A comprehensive review of the factors predicting technical difficulty in laparoscopic cholecystectomy

“…Previous episodes of hospitalisation was found to be a statistically significant risk factor for conversion. 1,2,7,9,10,12 This was presumed due to more adhesions at the Calot's triangle due to adhesions. Signs of acute cholecystitis were investigated by authors either with clinical signs or laboratory parameters like WBC count.…”

“…The impacted stone was found to be a significant risk factor for conversion. 9,10,12 The size of the stone was investigated by Jethwani et al and found to be a significant factor. 8 Larger stones increased the risk of difficulty and conversion.…”