Can we predict difficult laparoscopic cholecystectomy preoperatively? A comprehensive study
DOI:
https://doi.org/10.18203/2320-6012.ijrms20240222Keywords:
Difficult cholecystectomy, Laparoscopic, Preoperative scoreAbstract
Background: In the study, we have tried to assess some preoperative factors (history, clinical and ultrasonographic factors) that might make the laparoscopic cholecystectomy difficult. Objective was to study the predictive scoring pattern in difficult laparoscopic cholecystectomy cases.
Methods: It was a prospective observational study. Ninety cases of suspected cholecystitis were identified for study presented to Jehangir hospital, Pune with upper abdominal pain or vomiting or dyspepsia or jaundice. Such patients were studied in detail clinically, admitted and investigated. Ultrasound abdomen was done in all patients.
Results: Out of 90 cases studied, 64 patients (71.1%) had pre op score between 0-5 i.e. easy level, 21 patients (23.3%) had pre-op score between 6-10 i.e. difficult level and 5 patients (5.6%) had pre-op score between 11-15 i.e. very difficult level against intra-op scoring of 57 patients (63.33%) being easy, 28 patients (31.1) difficult and 05 patient (5.6%) had very difficult surgery. Conversion rate in present study to open surgery was 5.6%. For predicting easy laparoscopic cholecystectomy, accuracy of preop score was 85.6% and for predicting very difficult lap cholecystectomy, accuracy of preoperative score was 95.6%.
Conclusions: Strongly significant factors predicting difficult laparoscopic cholecystectomy were number of hospitalisations, impacted stone and obesity. This study demonstrated that a scoring system predicting the difficulty in laparoscopic cholecystectomy is feasible and easy way. Identification of these factors preoperatively might help to psychologically prepare the patients for open surgery and for prolonged convalescence.
References
Udwadia TE, DS Bhandarkar DS. The operative Technique for Laparoscopic Cholecystectomy. Comprehensive Laparoscopic surgery. LAGES Mew Letter. 2018;28:82.
Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg. 2009;71(4):198-201.
Bernard Rosner. Fundamentals of Biostatistics. 5th edn. Brooks/Cole, Cengage Learning; 2000:80-240.
Riffenburg RH. Statistics in Medicine. 2nd edn. Elsevier; 2005:85-125.
Rao SPS, Richard J. An Introduction to Biostatistics, A manual for students in health sciences. 4th edn. New Delhi: Prentice Hall of India; 2006:86-160.
Paidipelly KK, Sangamitra. Risk factors for the conversion of laparoscopic to open cholecystectomy. Int Surg J. 2018;5:2470-4.
Schrenk P, Woisetschlager R. Laparoscopic cholecystectomy. Surg Endosc. 1995;9(1):25.
Gabriel R, Kumar S, Shrestha A. Evaluation of predictive factors for conversion of laparoscopic cholecystectomy; Kathmandu Univ Med J. 2009;7(1):26-30.
Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993;217(3):233 6.
Liu CL, Fan ST, Lai EC, Lo CM, Chu KM. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg. 1996;131(1):98-101.
Khetan AK, Meenakshi Yeola M. Preoperative prediction of difficult laparoscopic cholecystectomy using a scoring system. Int Surg J. 2017;4(10):3388-91.
Kanaan SA, Murayama KM, Merriam LT, Dawes LG, Rege RV, Joehl RJ. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res. 2002;106(1):20-4.
Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery. 2007;142:556-65.
Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167(1):35-41.
Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS. 2002;6(1):59.
Singh K, Ohri A. Difficult laparoscopic cholecystectomy: a large series from north India. Indian J Surg. 2006;68(4):205-8.