Preoperative predictors of a difficult laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge to complete at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods: All cases of gallstone disease undergoing LC at a tertiary care hospital were studied over one year. Patients with jaundice, abnormal liver function tests, concomitant common bile duct stones, ongoing acute cholecystitis or concurrent gallstone pancreatitis were excluded. Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with different aspects of difficult LC.Results: 166 patients were studied with age ranging from 10-80 years, maximum incidence (36.14%) being in the age group 35-50 years. The time taken for LC increased significantly with increasing age. 70.48% were females but gender status did not affect the difficulty. Pain in the preceding 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (7.69% in patients with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness ≥4mm made LC longer, while multiple stones increased surgeon’s difficulty and impacted stone in gallbladder neck increased the conversion rate.Conclusions: Certain factors that increase the difficulty of LC can be identified preoperatively and this knowledge should be used when planning LC.

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

“…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.…”

Gall Bladder Wall Thickness as a Predictor for Laparoscopic Cholecystectomy Difficulties in Gadarif, Eastern Sudan

“…In our study, neither the number of acute attacks, nor the conversion found to be significantly associated with increasing GBWT this is contrast to what Nidoni et al [6] found in their study where they reported statistically significant association between the rate of conversion to open and number of acute attacks. Majority of our patients who had multiple stones which were not impacted, had a normal GBWT; in contrast to Kulkarni and Kumar who stated that; multiple stones increased surgeon's difficulty and impacted stone in gallbladder neck increased the conversion rate [20].…”

“…Majority of patients had multiple stones which were not impacted, had normal gallbladder caliber and normal wall thickness; in contrast to Kulkarni and Kumar et al who stated that multiple stones increased surgeon's difficulty and impacted stone in gallbladder neck increased the conversion rate [7].…”

Evaluation of preoperative scoring system for predicting difficult laparoscopic cholecystectomy

“…Randhawa and Pujahari[ 3 ] came up with a systemic scoring system to predict the level of difficulty in LC. This scoring system takes into account demographic factors such as age,[ 4 - 7 ] gender,[ 8 ] hospitalization history for acute cholecystitis,[ 9 , 10 ] clinical factors such as BMI,[ 11 ] the presence of abdominal scar,[ 12 ] palpability of gallbladder, and sonographic features such as wall thickness,[ 13 ] pericholecystic collection, and impacted stone[ 14 , 15 ] as the predictors of difficulty.…”