DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20151188

Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

Gaurav Gupta, Pranav Kumar Sharma, Sangita Gupta, Ankit Bhardwaj

Abstract


Background: Cholecystectomy is the procedure of choice for symptomatic gall stones. Laparoscopic Cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult LC. Preoperative prediction of a difficult LC can help the patient as well as the surgeon prepare better for the intraoperative risk and the risk of conversion to open cholecystectomy. The present study was undertaken to evaluate role of various factors responsible for conversion from laparoscopic to open cholecystectomy and also to study the intraoperative problems faced by the surgeon responsible for conversion in order to make the procedure safer for the patient as well as the surgeon.

Methods: In 50 consecutive patients who underwent LC during 2013 to 2014 patient’s characteristics, clinical history, laboratory data, ultrasonography results and intraoperative details were prospectively analyzed to determine predictors of difficult LC.

Results: Of 50 patients 3 (06%) required conversion to open cholecystectomy. Significant predictors of conversion were obscured anatomy of Calot’s due to adhesions, sessile gall bladder, male gender and gall bladder wall thickness >3 mm.

Conclusions: With preoperative clinical and ultrasonographic parameters, proper patient selection can be made to help predict difficult LC and a likelihood of conversion to open cholecystectomy.

 


Keywords


Difficult, Laparoscopic cholecystectomy, Ultrasonographic parameters, Open cholecystectomy

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References


Mühe C. Cholecystektomie durch das Laparoskop. Langenbecks Arch Klein Chir. 1986;369:804.

Nachnani J, Supe A. Preoperative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol. 2005;24(1):16-8.

Sanabria JR, Gallinger S, Croxford R, Strasberg Sm. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg. 1994;179:696-704.

Fried GM, Barkun JS, Sigman HH, Lawrence J, Clas D, Garzan J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167:35-41.

Abdel Baki NA, Motawei MA, Soliman KE, Farouk AM. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. JMRI. 2006;27(3):102-7.

Angrisanil L, Lorenzo M, De Palma G. Laparoscopic cholecystectomy in obese patients compared with non-obese patients. Surg Laparosc Endosc. 1995;5:197-9.

Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997;21:629-33.

Sanabria JR, Gallinger S, Croxford R, Strasberg SM. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg. 1994;179:696-704.

Kologan M, Tutuncu T, Yuksek YN Gozalan U, Daglar G, Kama NA. Using a risk score for conversion from laparoscopic to open cholecystectomy in resident training. Surgery. 2004;135:282-7.

Daradkeh SS, Suwan Z, Abu-Khalaf M. Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy. World J Surg. 1998;22:75-7.

Santambrogio R, Montorsi M, Bianci P, Opocher E, Schubert L, Verga M, et al. Technical difficulties and complications during laparoscopic cholecystectomy: predictive use of preoperative ultrasonography. World J Surg. 1996;20:978-82.

Phillips H, Carroll BJ, Fallas MJ, Pearlstein AR. Comparison of laparoscopic cholecystectomy in obese and non-obese patients. Am Surg. 1994;60:316-21.

Schirmer BD, Dix J, Edge SB. Laparoscopic cholecystectomy in the obese patient. Ann Surg. 1992;216:146-52.

Sikora SS, Kumar A, Saxena R, Kapoor VK, Kaushik SP. Laparoscopic cholecystectomy: can conversion be predicted? World J Surg. 1995;19:858-60.

Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M. A risk scores for conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001;181:520-5.

Dezeil DJ, Millikan KW, Econmou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy - A national survey of 4292 hospitals and an analysis of 77604 cases. Am J Surg. 1993;165:9-14.

Sharma SK, Thapa PB, Pandey A, Kayastha B, Poudyal S, Uprety KR, et al. Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound. Kathmandu Univ Med J. 2007;5(1):8-11.

Gabriel R, Kumar S, Shrestha A. Evaluation of predictive factors for conversion of laparoscopic cholecystectomy. Kathmandu Univ Med J. 2009;7(1):25-30.