Pre-operative Predictive Factors for Difficult Laparoscopic Cholecystectomy at Tertiary Care Centre

Abstract

INTRODUCTION Gallstones are present in 10 to 15% of general population and asymptomatic in more than 80% cases. Laparoscopic cholecystectomy is a gold standard treatment for cholelithiasis. The rate of conversion from laparoscopic cholecystectomy to open is about 1-13%. Predicting the difficulty of laparoscopic cholecystectomy is essential to optimize patient outcomes. The levels of difficulties during laparoscopic cholecystectomy can be predicated based on certain preoperative clinical, laboratory or radiological parameters. The main aim of the study was to find out the pre-operative predictive factors for difficult laparoscopic cholecystectomy at a tertiary care centre.

MATERIAL AND METHODS This was an observational cross-sectional study that included sixty nine patients who underwent elective laparoscopic cholecys- tectomy in UCMS. Preoperative predictive parameters such as age, gender, BMI, previous abdominal surgery, gallbladder condition, and ultrasound findings were assessed. A scoring system developed by Randhawa and Pujahari was used to predict difficulty in laparoscopic cholecystectomy, and intraoperative criteria were used to categorize cases as easy or difficult.

RESULTS History of acute cholecystitis (p=0.026), previous abdominal scar (p=0.024), thick gallbladder wall (p=0.012), impacted stone (p=0.057), pericholecystic fluid collection (p<0.001) and increased BMI were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity for easy - difficult cut off of the scoring method were 75.6% and 67.16%, respectively, with the area under the ROC curve being 0.524.

CONCLUSION The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on preoperative scoring system.