Preoperative prediction of difficult lap chole: a scoring method

Abstract

Background Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times it is easy and can be done quickly. Occasionally it is diffi cult and takes longer time. But there is no scoring system available to predict the degree of diffi culty of LC preoperatively.

Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients

“…Low risk patients could be identified and appropriately scheduled in an ambulatory care facility, and selected as training cases for surgical trainees, 9 whilst high risk patients should be appropriately counselled and operated by experienced surgeons. The majority of studies that have evaluated risk factors for conversion to open cholecystectomy are small retrospective series or population-based databases [1][2][3][4]6,7,[10][11][12][13][14] (Table 1). Several studies have developed risk scores, but their clinical utility is limited by retrospective data, small sample sizes and/or lack of validation.…”

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

“…1,2,6,13 An interesting observation by Randhawa et al in his study states a palpable gallbladder as a significant predictor of intraoperative difficulty. 10 This was one of the unique predictive factor identified by the author. Patil et al too reiterated this in his study where a statistical significance was observed with this variable.…”

“…9 Genc V et al and Randhawa et al did not find any statistical significance for previous abdominal surgery in prediction of difficult lap cholecystectomy. 6,10 This was attributed to experience of authors in adhesiolysis.…”

“…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.…”

Preoperative Prediction Difficult Laparoscopic Cholecystectomy

“…Dear Editor, I read with interest the recent article on: Preoperative prediction of difficult lap chole: a scoring method [1].…”