Analysis of predictors of a difficult laparoscopic cholecystectomy

Abstract

Background:Laparoscopic cholecystectomy is the gold standard for gall stone disease at present. However, conversion to open surgery is necessitated in specific circumstances. The aim was to analyze the factors which are likely to predict a difficult cholecystectomy necessitating conversion to open surgery.

Methods: Retrospective analysis was done from January 2013 to December 2013 of patients who underwent laparoscopic cholecystectomy and analysis of various factors like patient's age, sex, presence of co-morbidities like diabetes mellitus, laboratory values (including bilirubin, total count and alkaline phosphatase) and ultrasound finding like pericholecystic fluid, gall bladder thickness and the presence of a CBD stone between two groups of patients classified as difficult and easy cholecystectomies.

Results:Presence of pericholecystic fluid on ultrasound, mean total count and the presence of diabetes were found to be significant in predicting difficult cholecystectomies.

Conclusions:Factors like ultrasonic features of pericholecystic fluid, increased mean total count and the presence of diabetes are strong predictors of a difficult laparoscopic cholecystectomy. These factors should be used pre operatively as a predictive tool and will help the surgeon and patient prepare well in advance.