Research Paper

Preoperative Predictors Of A Difficult Laparoscopic Cholecystectomy

Abstract :

Background:Laparoscopic cholecystectomy (LC), the gold standard of treatment of gallstone disease, is a widely performed surgery, but it can become a challenge at times. Aim of present study was to find out the possible preoperative features in a gallstone disease patient that predispose him to having a difficult LC. Methods:All cases of gallstone disease undergoing LC at Government General Hospital, Guntur were studied over one year Various preoperative clinical, laboratory and ultrasound parameters were studied to see their correlation with difficult LC. The cases confirmed by USG were evaluated with the following risk factors: age>50yrs,male sex, BMI 25.1-27 and >27.5,prior surgery, prior hospital admission, palpable gall bladder, gall bladder thickening, impacted stone, pericholystitic collection. Each risk factor is given a score.The total score upto 5 predicted easy surgery, 6-10 difficult and >10 is very difficult surgery. Results: 85 patients were studied with age ranging from 21-65 years, maximum incidence (53%) being in 35-50 years. The time taken for LC increased significantly with increasing age. 60% were females but gender status did not affect the difficulty. Pain in the past 15 days of surgery increased the operating time as did the association of diabetes mellitus. Increasing body mass index (BMI) also increased the surgery time as well as the conversion rate (more with BMI >30Kg/m2). Clinically palpable gallbladder increased the surgery duration, difficulty and conversion rate. TLC >11000/mm3, contracted gallbladder, wall thickness 4mm made LC longer, while multiple stones increased surgeons difficulty and impacted stone in gallbladder neck increased the conversion rate. The highest age incidence of cholelithiasis was in the 4th decade, and was more common in females. Pain abdomen was the most common symptom. BMI >27.5 (P

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