Validation of a scoring system to predict difficult laparoscopic cholecystectomy

Gupta, Nikhil; Ranjan, Gyan; Arora, Mansi; Goswami, Binita; Chaudhary, Poras; Kapur, Arun; Kumar, Rajeev; Chand, Tirlok

doi:10.1016/j.ijsu.2013.05.037

Cited by 121 publications

(165 citation statements)

References 15 publications

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“…Gupta N et al found that it was not a significant factor in their study, but owed it to a sample bias. 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.…”

Section: History Of Previous Surgeriesmentioning

confidence: 89%

“…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.…”

Section: Clinical Parameters-disease Factorsmentioning

confidence: 99%

“…The impacted stone was found to be a significant risk factor for conversion. 9,10,12 The size of the stone was investigated by Jethwani et al and found to be a significant factor. 8 Larger stones increased the risk of difficulty and conversion.…”

Section: Radiological Parametersmentioning

confidence: 99%

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

Menon¹

2017

Int Surg J

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Laparoscopic cholecystectomy is the most common laparoscopic procedure performed all over the world. It has now become the gold standard management for symptomatic gallstones. Aim of the study was to identify and highlight the predictive factors determining intra operative technical difficulty in laparoscopic cholecystectomy. A database search was done in Medline, Google scholar and Journal seek using keywords ‘Laparoscopic Cholecystectomy’, ‘difficult cholecystectomy’ and ‘predictive factors’. 54 abstracts were shortlisted out of which 15 were selected based on the time of publication (after 2005), size of study group, relevance to the title, level of evidence and the journal of publication. Results were compared and reviewed and the conclusion was reached. Fifteen papers were reviewed based on literature search and statistically significant variables predicting the technical difficulty in Laparoscopic cholecystectomy was found. These were age, sex, obesity, previous upper abdominal surgeries, comorbid diseases like Diabetes, acute cholecystitis, raised WBC counts, gall bladder wall thickness more than 3mm, presence of pericholecystitic collection, single impacted stone, multiple stones, contracted gall bladder, adhesions at Calot’s triangle, intrahepatic gall bladder, complications like gangrenous GB and fistulisation. The predictive risk factors reviewed here need to be kept in mind by the laparoscopic surgeon during a laparoscopic cholecystectomy. Though none of them is an absolute contraindication, presence of these factors demand modifications in technique for a safe laparoscopic surgery.

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Section: History Of Previous Surgeriesmentioning

confidence: 89%

Section: Clinical Parameters-disease Factorsmentioning

confidence: 99%

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

Menon¹

2017

Int Surg J

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“…12 Even though there are various preoperative scoring systems but there is no operative classification associated with laparoscopic surgery. 13,14 Various predictors have been assessed to evaluate the degree of difficulty encountered during surgery. In our study, there were a total 8 subjects with gall wall thickness more than 4mm.…”

Section: Discussionmentioning

confidence: 99%

“…According to a study conducted by N Gupta et al, peri cholecystic fluid collection was not found a significant factor associated with conversion to open case in contrast to our study. 21 Therefore scoring system is a useful tool to evaluate the chances of conversion of laparoscopic case to an open cholecystectomy.…”

Section: Discussionmentioning

confidence: 99%

Role of scoring system in prediction of difficult laparoscopic cholecystectomy

Rhezhii¹,

Goyal²,

Nagpal³

et al. 2017

Int Surg J

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Background: One of the most common reasons for admission to hospital is cholecystectomy and it has a mortality rate of 0.45% to 6%. Many risk factors have been found to be associated laparoscopic cholecystectomy that make it difficult like advance age, male gender, fever, obesity, previous abdominal surgeries, thick gall bladder lining, distention of bladder, presence of gall stones. There have been different scoring systems in literature that determine the risk of conversion to open cholecystectomy. The aim of present study is to determine the role of scoring system in predicting difficult laparoscopic surgery.Methods: The present prospective study was conducted for a period of 1 year in the Department of Surgery at Guru Gobind Singh Medical College, Faridkot, Punjab. The study included all the patients with symptomatic gall stones reporting to the OPD of the hospital. Patients were categorized into two groups after the surgery. Group I included patients who underwent successfully laparoscopic cholecystectomy and group II included those who were converted into an open case. In this study all the entities were provided with a score. Patients with score less than 4 were grouped as difficult. At the end of the study all the data were analyzed to see how scoring system can predict which patients will have easy or difficult laparoscopic cholecystectomy based on postoperative scoring. All the data was recorded in a tabulated form and analyzed using SPSS software.Results: The present prospective analytical study involved 112 subjects; out of these 94 were males and 18 females. The mean age of subjects was 48.2±3.7 years. There were 98 patients in Group I and 8 patients in group II who had didn’t show presence of peri cholecystic fluid. There was 1 patient in Group I and 5 patients in group II who had peri cholecystic fluid on ultrasound. There were 104 subjects with gall was thickness less than 4 mm. There were 95 patients in Group I and 9 patients in group II who had who had who had bladder wall thickness of less than 4 mm.Conclusions: The scoring tool evaluated in our study is useful in evaluating the risk of conversion of laparoscopic cholecystectomy into open cholecystectomy.

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Response to: Meticulous surgical technique cannot be replaced by cholangiography

Lehrskov

2020

British Journal of Surgery

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Validation of a scoring system to predict difficult laparoscopic cholecystectomy

Cited by 121 publications

References 15 publications

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

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

Role of scoring system in prediction of difficult laparoscopic cholecystectomy

Response to: Meticulous surgical technique cannot be replaced by cholangiography

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