Predicting difficult laparoscopic cholecystectomy

Gupta, Atul; Shiwach, Nitin; Gupta, Shalabh; Goel, Anita; Bhagat, Tripta S

doi:10.18203/2349-2902.isj20180837

Cited by 16 publications

(22 citation statements)

References 16 publications

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“…11 Vivek et al described similar results when they reported the role of increasing age, male gender, high BMI, previous biliary disease, previous surgery, and preoperative sonological findings in accurately predicting the intra operative difficulties of laparoscopic cholecystectomy. 12 Similar results were also obtained by Gupta et al and Kulkarni et al 13,14 The study found the scoring system developed by Randhawa and Pujari et al to have a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2% in the prediction of difficult laparoscopic cholecystectomies. However, Randhawa and Pujari et al reported a sensitivity and specificity of 75.00% and 90.24%, respectively.…”

Section: Discussionsupporting

confidence: 61%

Can difficulties in laparoscopic cholecystectomy be anticipated preoperatively: evaluation of a scoring system

et al. 2020

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Background: Laparoscopic cholecystectomy is often associated with intra operative difficulties leading to increased intra and post-operative morbidity. Accurate prediction of a difficult laparoscopic cholecystectomy can reduce the complication rate, rate of conversion and overall medical cost. This study was an attempt to validate a scoring system developed to predict difficult laparoscopic cholecystectomy.Methods: 100 patients undergoing laparoscopic cholecystectomy were included. Details such as age, sex, BMI, previous surgical history, history of hospitalisation for biliary disease, sonographical wall thickness, pericholecystic collection and presence of impacted stone were noted. With these, pre-operative score was calculated using the scoring system. Intra operative details and complications were noted and were classified as easy, difficult and very difficult. Student t test and chi square test was used to test the difference of significance (p<0.05).Results: Male sex, higher BMI, a history of previous surgery, a history of prior hospitalisation for biliary disease, a palpable gall bladder, a thickened gall bladder wall, impacted stone and pericholecystic collection all had a statistically significant accurate prediction of the difficulty in laparoscopic cholecystectomy. The mean duration of surgery was 62.7±33.15 minutes. The scoring system developed by Randhawa et al predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.Conclusions: The proposed scoring system predicted difficult laparoscopic cholecystectomy with a sensitivity of 77.8%, specificity of 78.1%, positive predictive value of 66.7% and a negative predictive value of 86.2%.

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Section: Discussionsupporting

confidence: 61%

Can difficulties in laparoscopic cholecystectomy be anticipated preoperatively: evaluation of a scoring system

et al. 2020

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“…[10][11][12] Some authors have reported no significant relation between gall bladder wall thickness and a difficult laparoscopic cholecystectomy whilst others have reported it to be significant. 8,13 Present study found this relation to be statistically significant.…”

Section: Discussionmentioning

confidence: 45%

“…These findings are consistent with other studies conducted by various authors. [8][9][10] A significant relation was found by us between previous attacks of acute cholesystitis and intra-operative difficulty during laparoscopic cholecystectomy. Similar findings have been corraborated by various authors in litreature.…”

Section: Discussionmentioning

confidence: 89%

“…In the litreature certain authors have reported similar findings whilst others do not concur with it. 8,13 Patients having BMI more than 30 was significantly related to difficult cholecystectomy, the difficulty arose while gaining intraperitoneal access, dissecting at calots triangle due to excess fat and while extracting the gall bladder and its contents from the peritoneal cavity. Various authors have reported similar findings.…”

Section: Discussionmentioning

confidence: 99%

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Pre-operative factors for predicting a difficult laparoscopic cholecystectomy

2018

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Background: Laparoscopic cholecystectomy is a very safe procedure yet there are instances where serious complications can be avoided and better managed if the surgeon is forewarned or prepared in advance for them. So, a need is felt to identify pre-operative parameters for anticipating a difficult cholecystectomy.Methods: This study was carried over a period of two years (2007- 2009). Patients having symptomatic cholelithiasis willing to undergo laparoscopic cholecystectomy were enrolled in the study. The following pre-operative parameters were evaluated in the study: age, sex, body mass index, history of previous abdominal surgery, history of acute cholecystitis, history of biliary colic, palpable lump in right hypochondrium, experience of the surgeon and abdominal ultrasonogram (following parameters were noted increased gallbladder wall thickness, number of stones, size of largest stone and its location).Results: Acute cholecystitis, palpable gall bladder, increased gallbladder wall thickness, biliary colic, gall stones >2 cm in size, gall stone impacted at gallbladder neck and BMI >30 kg/m2 had a significant p-value in a difficult laparoscopic cholecystectomy.Conclusions: Further research is needed to formulate a score based on the variables mentioned above to predict a difficult laparoscopic cholecystectomy and hence letting the surgeon be better prepared for any eventualities that he encounters whilst performing laparoscopic cholecystectomy.

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“…Spillage of gallbladder contents during LC has been extensively explained as a factor for the conversion of LC to open surgery and difficult LCs. [ 26 27 28 ] Even, Rice et al . have presented an increased risk of postlaparoscopic intra-abdominal abscess formation.…”

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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Predicting difficult laparoscopic cholecystectomy

Cited by 16 publications

References 16 publications

Can difficulties in laparoscopic cholecystectomy be anticipated preoperatively: evaluation of a scoring system

Can difficulties in laparoscopic cholecystectomy be anticipated preoperatively: evaluation of a scoring system

Pre-operative factors for predicting a difficult laparoscopic cholecystectomy

Could preoperative sonographic criteria predict the difficulty of laparoscopic cholecystectomy?

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