Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Joshi, Mukund Raj; Bohara, Tanka Prasad; Rupakheti, Shail; Parajuli, Anuj; Shrestha, Dipendra Kumar; Karki, D B; Laudari, Uttam

doi:10.31729/jnma.2734

Cited by 7 publications

(9 citation statements)

References 9 publications

(18 reference statements)

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“…This observation is supported by the magnitude of PPV (positive predictive value) in comparison to the NPV (negative predictive values), 85%, 87% respectively and the overall accuracy of 86.9%. These results are favorably in agreement with what was mentioned by Joshi M et al [14]. They suggested a scoring system to predict difficult laparoscopic cholecystectomy which had a PPV and NPV of 63.6% and 84.6% respectively.…”

Section: Discussionsupporting

confidence: 92%

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Bin-Gadeem

2022

Univ. Aden J. Nat. and Appl. Sc.

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Preoperative scoring system to predict difficult laparoscopic cholecystectomy can be regarded as an instrument in the hand of the surgeon, which could help him to prepare for difficult operation, make better preoperative counseling of the patient, and in general, it is a further step towards the safe, modern, surgical practice. The study aimed developing a simple scoring system to predict difficult laparoscopic cholecystectomy preoperatively, which can be used in the daily clinical practice. This is a retrospective study carried out in the 22 May Hospital, Aden, from 1st March 2018 to 29th February 2020. It included 405 patients who had laparoscopic cholecystectomy, and among them, 137 had difficult operation. 10 variables were subjected for multivariate study (binary logistic regression) which had shown association with difficult laparoscopic cholecystectomy on previous univariate analysis. Statistical software SPSS version 17 was used for this purpose and significance level was set to p< 0.05. The necessary predictors (independent factors) which were able to explain the outcome (difficult laparoscopic cholecystectomy) were identified with statistical significance. The effect size of these predictors was rounded and the new values were adopted as scores for each factor. A scoring system was constructed from these factors and their scores. The accuracy of the new score system was tested by the ROC analysis against the same sample.7 predictors were identified. Depending on these variables, the prediction for easy laparoscopic cholecystectomy came true in 87% of cases and the prediction for difficult laparoscopic cholecystectomy came true in 85% of the cases. The returned area under the curve was 0.913, with 95% confidence interval. A score above 2.25 was considered difficult with sensitivity and specificity of 82.25% and 85.8% respectively. There were no cases with score above 9. From the findings of the current study, it could be concluded that the new scoring system had good predictive capability to difficult laparoscopic cholecystectomy and it incorporates simple, few determinants, which could help surgeon and improve patient curative care.

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Section: Discussionsupporting

confidence: 92%

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Bin-Gadeem

2022

Univ. Aden J. Nat. and Appl. Sc.

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“…[ 19 ] Therefore, it has been assumed that preoperative assessments such as ultrasonography may provide information for the prediction of LC difficulty, thus deciding to use the best surgical approach. [ 12 13 20 ]…”

Section: Discussionmentioning

confidence: 99%

Could preoperative sonographic criteria predict the difficulty of laparoscopic cholecystectomy?

et al. 2020

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Background: Although laparoscopic cholecystectomy (LC) is the gold standard approach for gallbladder diseases, this sometimes may face difficulties and require conversion to open surgery. The preoperative ultrasonographic study may provide information about the probability of difficult LC, but the data in this term are uncertain. We assessed the value of preoperative ultrasonographic findings for the prediction of LC's difficulty. Materials and Methods: The current prospective clinical trial was conducted on 150 patients who were candidates for LC due to symptomatic gallstone. All of the patients underwent ultrasonography study preoperatively, and then, LC was performed. The surgeon completed a checklist regarding the easy or difficult surgical criteria. Finally, the values of ultrasonographic findings for the prediction of LC difficulty were evaluated. Results: Among the 150 included patients, 80 had easy LC and 70 had difficult LC. Statistically significant differences were found between the two groups of easy and difficult LC regarding gallbladder wall thickness ( P = 0.008), stone impaction ( P = 0.009), and gallbladder flow ( P = 0.04). The area under the curve (standard error [SE]) for the thickness of the gallbladder wall, flow in the gallbladder wall, and stone impaction was 0.598 ± 0.048, 0.543 ± 0.047, and 0.554 ± 0.047, respectively ( P < 0.05). The highest specificity was for gallbladder wall flow (100%). Binary logistic regression showed that stone impaction had predictive value for determining difficult LC (odds ratio = 3.10; 95% confidence interval: 1.03–9.30; P = 0.04). Conclusion: Although a significant difference was observed between two groups in terms of impacted stone, flow in the gallbladder wall, and thickness of the gallbladder wall, only stone impaction had predictive value for determining difficult LC.

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“…Many clinical, radiological and laboratory investigation findings are indicative of difficult laparoscopic cholecystectomy [8,9]. Even many scoring methods depending on clinical and investigative factors have been devised 5,10 . It had been concluded from all these studies that age more than 50 years, male sex, BMI > 25, history of previous recurrent attacks, previous abdominal surgery, palpable gall-bladder, increased wall thickness, presence of peri-cholecystic fluid and impacted or large stone are associated with difficult laparoscopic cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate

Verma¹,

Chand²,

Sharma³

et al. 2020

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Gall stone disease is a common gastrointestinal surgical problem and symptomatic patients needs appropriate and timely treatment in the form of cholecystectomy else the disease process becomes complicated because of recurrent chronic infection, dislodgement of stone to common bile duct, acute infection and more severe complications like perforation of gall bladder. In recent years, Laparoscopic Cholecystectomy is considered as gold standard treatment for symptomatic as well as for few categories of asymptomatic cholelithiasis. Reduced postoperative pain, early return of mobility and to work, cosmetic results and brief hospital stay are distinct advantages of the procedure. Laparoscopic Cholecystectomy becomes difficult in patients with male sex, age above 50 years, obese, history of previous hospitalization due to attacks, previous abdominal surgery scar, palpable gall bladder, impacted stone, overdistended/contracted gall bladder. Various scoring systems have been reported to predict difficult laparoscopic cholecystectomy preoperatively. These difficult cases required longer operating time and hospital stay. The incidence of postoperative complications are also higher as compared to easy Laparoscopic Cholecystectomy Of the total 430 cases included in this study, 200 (46.5%) cases were difficult cases. For performing Laparoscopic Cholecystectomy in these patients successfully i.e. with minimum conversion to open, certain modifications in the classical four-port technique were done. As a result, conversion rate in difficult laparoscopic cholecystectomy could be limited to 7% only. Postoperative complication were pyrexia (21.5%), paralytic ileus (9.5%), bile stained subhepatic discharge (6.5%), port site infection (8%) and respiratory complications (8%). Late complication was port-site hernia (0.5%). Operating time 58.7+12.4 minutes in difficult laparoscopic cholecystectomy as compared to 36.5+9.2 minutes in easy cases and postoperative hospital stay was of 6.9+1.8 days against 2.3+0.8 days as compared to easy cases. Unclear anatomy (3%), haemorrhage (4%), dense adhesions (2%) and anaesthesia issue (1%) were the reasons of conversion to open cholecystectomy. It is concluded from this study that preoperative difficult laparoscopic cholecystectomy can be predicted and modifications of the steps of four-port cholecystectomy can be done to minimize the conversion rate.

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Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Cited by 7 publications

References 9 publications

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Could preoperative sonographic criteria predict the difficulty of laparoscopic cholecystectomy?

Modification of Step in Difficult Laparoscopic Cholecystectomy to Minimize the Conversion Rate

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