Evaluation of preoperative predictive factors that determine difficult laparoscopic cholecystectomy

Abstract

Background:Cholelithiasis is the most common biliary pathology. Gallstones are present in 10 to 15% of the general population and asymptomatic in the majority (>80%). The prevalence of gallstone varies widely in different parts of the world. In India it is estimated to be around 4%. Since laparoscopic cholecystectomy is the most common procedure done now days we undertook a study to evaluate factors determining difficult laparoscopic cholecystectomy. The objective of the study was to evaluate preoperative data that can serve as predictors of difficult laparoscopic cholecystectomy and help in planning of surgery.

Methods: Patients presenting with upper abdominal discomfort and sonographically confirmed cholelithisis were studied in terms of several clinical factors and scoring system was devised. Based on scoring system patients were categorised and evaluated post operatively.

Results:In present study prior history of hospitalisation (p<0.001), previous abdominal surgeries (p<0.01), palpable gall bladder (p<0.01), BMI >27.5 (p<0.01), thickened GB wall (p<0.001) were found to be significant predictors of difficult laparoscopic cholecystectomy. Remaining parameters like age, sex, impacted stone and pericholecystic collection were not found significant predictors of difficult laparoscopic cholecystectomy.

Conclusions:Difficult laparoscopic cholecystectomy can be predicted preoperatively based on parameters used in the study. Knowledge of these factors for difficult laparoscopic cholecystectomy could help surgeons during pre-operative assessment and improve the informed consent.