Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

Gupta, Gaurav; Sharma, Pranav; Gupta, Sangita; Bhardwaj, Ankit

doi:10.18203/2320-6012.ijrms20151188

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…While comparing with the other studies the conversion rate of laparoscopic to open cholecystectomy ranged between 7% and 35% [ 12 ]. In our study, adhesion of dense nature from severe cholecystitis or an inability to distinguish anatomy was the major factor for the conversion of laparoscopic to open cholecystectomy, and similar causes for the conversion of laparoscopic to open cholecystectomy were observed in other studies [ 13 , 14 ].…”

Section: Discussionsupporting

confidence: 86%

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre

Pal¹,

Ahluwalia²,

Sachdeva³

et al. 2023

Cureus

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BackgroundIn comparison to a traditional cholecystectomy (open), the laparoscopic cholecystectomy approach provides a number of benefits and has been demonstrated in some studies to have a greater complication rate. The conversion rate from laparoscopic to open surgery ranged between 2% and 15%. A preoperative scoring or grading system (based on age, sex, history, clinical examination, laboratory, and sonographic results) was developed by Nassar et al., to anticipate the challenge of laparoscopic cholecystectomy. So, we conducted this study to assess the degree of difficulty in faced during laparoscopic cholecystectomy using an intraoperative scoring system and validate the same using the preoperative scoring system. MethodsWe conducted this study in the department of General Surgery among 105 patients who underwent laparoscopic cholecystectomy during the defined study period of one year. We performed the preoperative workup for all patients. A preoperative scoring or grading system developed by Nassar et al., in 2020 was used. In our study, laparoscopic cholecystectomy was performed by surgeons having a minimum of eight years of hands-on experience in laparoscopic surgeries. An intraoperative scoring or grading system for the degree of difficulty during laparoscopic cholecystectomy, developed by Sugrue et al., in 2015 was used. The Chi-square test was applied to assess the association between preoperative variables and the intraoperative score grading. We have also performed the receiver operating characteristic (ROC) curve analysis to validate the preoperative score in predicting the intraoperative findings. All tests were considered statically significant if the p-value was < 0.05. ResultsIn our study, a total of 105 patients were included in the study and the mean age of patients was 57.6±16.4 years. The male patients were 58.1% and the remaining 41.9% were females. The primary diagnosis was cholecystitis among 44.8% of patients and 2.9% of patients were diagnosed with pancreatitis. Among enrolled patients, laparoscopic cholecystectomy was done on an emergency basis among 2.9% of subjects. During the laparoscopic cholecystectomy, among 21.0% and 30.5% of patients, there was a severe and extreme degree of difficulty respectively. In our study, the conversion rate from laparoscopic to open cholecystectomy was 8.6%. In our study, we found that at a preoperative score of 6, the sensitivity and specificity for predicting easy cases were 88.2% and 73.8%, respectively, and had an accuracy of 88.6% for easy cases and 68.5% for difficult cases. ConclusionWhen grading the difficulties of doing a laparoscopic cholecystectomy and determining the severity of cholecystitis, this intraoperative scoring system is effective and accurate. Additionally, it signifies the need for conversion from laparoscopic to open cholecystectomy in cases of severe cholecystitis.

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Section: Discussionsupporting

confidence: 86%

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre

Pal¹,

Ahluwalia²,

Sachdeva³

et al. 2023

Cureus

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“…The aim was to avoid serious postoperative complications, mainly bile tree injuries. Many risk factors for difficult cholecystectomy were identified, including age, male sex, episodes of acute cholecystitis, obesity, previous abdominal surgery, clinical signs of acute cholecystitis, and certain ultrasonographic findings [3]. Despite our best efforts, we were not able to find studies documenting a similar attempt for LS.…”

Section: Introductionmentioning

confidence: 99%

Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases

Wysocki

Radkowiak

Zychowicz

et al. 2018

JCM

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Prediction of intraoperative difficulties may be helpful in planning surgery; however, few studies explored this issue in laparoscopic splenectomy (LS). We performed retrospective analysis of consecutive 468 patients undergoing LS from 1998 to 2017 (295 women; median age 47 years). The patients were divided into difficult LS and control groups. The inclusion criteria for difficult LS were operative time ≥mean + 2SD; intraoperative blood loss ≥500 mL, intraoperative adverse events (IAE), conversion. Primary outcomes were risk factors for difficult splenectomy and secondary outcomes for perioperative morbidity. Fifty-six patients were included in the difficult LS group (12%). Spleens ≥19 cm and higher participation of younger surgeons in consecutive years were predictive for difficult splenectomy. Age ≥53 years and diagnosis other than idiopathic thrombocytopenic purpura (ITP) were independent risk factors of spleen ≥19 cm. The perioperative morbidity was 8.33%; its OR was increased only by blood loss and IAEs. Only blood loss significantly increased serious morbidity. Male sex, spleens ≥19 cm, and IAEs were independent risk factors for intraoperative hemorrhage. Spleen length ≥19 cm was a risk factor for difficult LS and intraoperative hemorrhage. Diagnoses other than ITP in patients aged ≥53 years with ≥19 cm spleens are predictive for intraoperative difficulties and perioperative complications.

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“…[13,14] They concluded that most important reason for OC was inability to visualize anatomy adequately. Gupta G et al (2015), [15] Tosun A et al (2015) & Gaurav Gupta et al (2015) evaluated role of various factors responsible for conversion from laparoscopic to open cholecystectomy and also studied the intraoperative problems faced by the surgeon responsible for conversion in order to make the procedure safer for the patient as well as the surgeon. [16,17] Significant predictors of conversion were obscured anatomy of Calot's due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm.…”

Section: Discussionmentioning

confidence: 99%

Role of Ultrasonography (USG) in Evaluation of Pericholecystic Adhesions in Gallstone Disease (GSD)

Wani¹,

Rastogi²,

Pratap³

et al. 2017

Ann. Int. Med. Den. Res.

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Background: In the recent era of laparoscopic and robotic surgeries, preoperative imaging has become very crucial in selecting the right operative technique in any pathological condition. Though laparoscopic cholecystectomy is widely accepted and practiced surgical technique yet it has limitations especially dense pericholecystic adhesions where the surgeon requires larger field of view for optimal dissection of gall bladder bed and for optimal control of bleeding. Though ultrasonography has been in wide use for preoperative evaluation of gall bladder stone disease yet very few studies have been conducted to evaluate its role in predicting pericholecystic adhesions responsible for difficult laparoscopic cholecystectomy. Prior knowledge of dense pericholecystic adhesions may help the surgeon in opting for open over laparoscopic cholecystectomy. Methods: Out of 70 patients with gall bladder stone disease that were enrolled in the study, complete data could be obtained in only 55 patients. All patients included in the study underwent ultrasonography of abdomen in fasting state and findings were recorded including pericholecystic adhesions & visualisation of Calot's triangle. The ultrasonographic findings were compared with that of the operative findings. Results: Our study revealed that ultrasonography has more than 70% sensitivity, more than 80% specificity and more than 76% accuracy in predicting pericholecystic adhesions which is the major cause of conversion from laparoscopic to open cholecystectomy. Conclusions: Ultrasonography can serve as an inexpensive imaging tool for predicting difficult laparoscopic cholecystectomy in patients with gall bladder stone disease by demonstrating signs of pericholecystic adhesions and nonvisualisation of normal-appearing Calot's triangle.

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Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

Cited by 4 publications

References 10 publications

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre

Prediction of Technical Difficulties in Laparoscopic Splenectomy and Analysis of Risk Factors for Postoperative Complications in 468 Cases

Role of Ultrasonography (USG) in Evaluation of Pericholecystic Adhesions in Gallstone Disease (GSD)

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