Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Abstract

Laparoscopic cholecystectomy become the treatment of choice for symptomatic gallstone disease. Difficult procedure may confront the surgeon, but these situations are often predictable based on a number of clinical and paraclinical factors. This study aimed to determine which clinical and paraclinical factors are associated with difficult laparoscopic cholecystectomy. Total of 405 patients with symptomatic gallstone disease, who underwent laparoscopic cholecystectomy between 1st Marc 2018 and 29th February 2020,in 22 May Hospital, Aden, were included in the study. Patient with gallbladder cancer or acalcular cholecystitis were excluded from the study. Relevant data which include clinical and paraclinical findings as well as operative findings were collected to a specially designed questionnaire form. Data analysis was done by SPSS version 17 software. Univariate analysis for categorical variables was done using Chi square or Fischer's exact test. Continuous data were tested for normal distribution and analyzed using Mann Whitney test. P- value <0.05 was considered statistically significant. Female preponderance (88.1%) was observed. Mean age was 42.6 ± 13.7. Difficult laparoscopic cholecystectomy found in 137 patients (33.8%). A statistically significant association were found between difficult laparoscopic cholecystectomy and gender (p-value <0.001), history of obstructive jaundice (p-value<0.001), previous endoscopic retrograde cholangio-pancreaticography (p-value <0.001), previous abdominal surgery (p-value =0.005), white blood cell count (p-value= 0.001), gallbladder wall thickness ≥ 4mm (p-value <0.001) , impacted stone in cystic duct (p-value <0.001), pericholecystic fluid collection (p-value <0.001), dilated common bile duct more than 7 mm (p-value =0.001), contracted gallbladder despite adequate fasting (p-value <0.001). Number of preoperative factors were identified, which have statistically significant association with difficult laparoscopic cholecystectomy. Knowledge of these factors by the surgeon before operation is imperative to make the necessary precautions before operation.

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

“…It is a retrospective study that included 405 patients who underwent laparoscopic cholecystectomy. Among them 137 cases had difficult laparoscopic cholecystectomy based on criteria mentioned in previous studies [6]. Data entry was done to statistical software IBM SPSS version 17 and included the dependent variable easy/difficult laparoscopic cholecystectomy and the preoperative independent which were noted to have statistically significant association with difficult laparoscopic cholecystectomy on univariate analysis [6].…”

“…Among them 137 cases had difficult laparoscopic cholecystectomy based on criteria mentioned in previous studies [6]. Data entry was done to statistical software IBM SPSS version 17 and included the dependent variable easy/difficult laparoscopic cholecystectomy and the preoperative independent which were noted to have statistically significant association with difficult laparoscopic cholecystectomy on univariate analysis [6]. In order to exclude confounding variables from further study a binary logistic regression analysis was used with forward LR method and the significant level was assumed at level p < 0.05.…”

“…In many recently published studies, difficult laparoscopic cholecystectomy was observed in about one third of the operated patients which make preoperative assessment for difficult operation and planning for safe surgery is prudent [5,6,19,24] . Undoubtedly, clinical and paraclinical assessment including imaging studies of patients with gallbladder stone disease, can reveal individual factors associated with difficult laparoscopic cholecystectomy and are indispensable parts in the management and decision making process [31].…”