Preoperative prediction of difficult laparoscopic cholecystectomy using a scoring system

Abstract

Background: Laparoscopic cholecystectomy (LC) has become gold standard for the surgical treatment of gallbladder disease. 2% to 15% of patients require conversion to open surgery for various reasons. Pre-operative prediction of “difficult laparoscopic cholecystectomy” may not only improve patient safety but also be useful in reducing the overall cost of therapy. The aim of this study is to study the factors determining the preoperative predictability of difficult laparoscopic cholecystectomy.Method: 30 cases of laparoscopic cholecystectomy operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. They were evaluated and scored on the basis of scoring system of Randhawa and Pujahari. Score up to 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult.Result: Previous history of hospitalization for cholecystitis and increased gall bladder wall thickness were found statistically significant in predicting difficult LC.Conclusion: The scoring system had a positive prediction value for easy prediction of 81.9% and for difficult prediction of 75%.

Predicting difficult laparoscopic cholecystectomy

“…20 Liu et al and Khetan A also reported previous history of acte cholecystitis as a significant predictor of difficult LC. 21,22 Acute cholecystitis may lead to increased gall bladder wall thickness and cause scarring and fibrosis in and around gall bladder, making subsequent surgery difficult. This assumption is supported by the findings.…”

Accuracy of Randhawa and Pujahari Preoperative Scoring System in Prediction of Difficult Laparoscopic Cholecystectomy in Egyptian Population

“…They found no significant correlation between age and the difficult level of surgery. This could be explained by the small sample size of the study population (30 cases) (9) . On the other hand, in a meta-analysis by Yang et al demonstrated that age >65 years is associated with a twofold increase in conversion rate from LC to open surgery (10) .…”

“…In 2017, Khetan et al study found that increased GB wall thickness is statistically significant predictor for difficult LC (9) . In 2007, Lipman et al study found that thickened gallbladder wall on ultrasound (US) is associated with high rate of CTO (19) .…”

“…In 2017, Khetan et al study found that previous history of hospitalization for acute attack of cholecystitis is statistically significant risk factor for difficult LC (9) . Boerma et al compared the two stage LC conducted for patients with residual gall stones within 6 weeks from ERCP with that performed 6 weeks after ERCP and found that, the latter was more technically demanding and associated with a threefold increase in the CTO rate (15) .…”

“…In 2017, Khetan et al study found that the scoring system had a positive prediction value for easy prediction of 81.9% and for difficult prediction of 75% (9) . In the present study prediction came true in 95% of easy cases and 77.8% of difficult cases, and there were no cases with score above 10.…”