The preoperative prediction of a difficult laparoscopic cholecystectomy

Abstract

INTRODUCTION: Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy mainly because of technical difficulty. The aim was to define the possibility of prediction of a difficult outcome preoperatively. AIMS AND OBJECTIVES: 1. To determine the possibility of predicting preoperatively a difficult laparoscopic cholecystectomy. 2. To determine the factors which significantly predict the outcome. 3. To identify patients at risk in an elective setting and thereby enable patient counselling. MATERIALS AND METHODOLOGY: 40 patients with symptomatic gallstones planned for elective surgery and operated upon by a single experienced laparoscopic surgeon were studied by assigning a score depending upon clinical and sonological parameters. RESULTS: Out of 40 cases, 11 had a difficult outcome with scores ranging between 5 and 10. None had a score >10. Age >50, Obesity, Previous hospitalization, Palpable gallbladder and Wall thickness > 4mm on ultrasonogram were found to significantly influence the outcome. The ideal cut off point was a score of 3, which could predict difficulty. Overall the positive predictive value was 78.57%. CONCLUSION: A difficult laparoscopic cholecystectomy can be predicted preoperatively. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty