Assessment of clinical, hematological, radiological parameters for prediction of difficult laparoscopic cholecystectomy at a tertiary health care centre
DOI:
https://doi.org/10.18203/2349-2902.isj20183404Keywords:
Cholelithiasis, Haematology, Laparoscopic cholecystectomy, UltrasonographyAbstract
Background: Since its introduction in the mid 1980’s, laparoscopic cholecystectomy (LC) has been widely used for symptomatic cholelithiasis. In recent years it has been considered as a gold standard for treatment of symptomatic cholelithiasis. Recent studies have reported that the rate of conversion of LC to open cholecystectomy (OC) is 1.5-19%. The aim of the present study was to predict the difficulties of performing laparoscopic cholecystectomy in symptomatic cholelithiasis. Further, the possibility of converting LC to open cholecystectomy was also investigated using various haematological, clinical, and radiological tool such as USG.
Methods: The present prospective study was conducted in in Nehru Hospital of BRD Medical College, Gorakhpur, India over a period of 12 months on in-patients from various surgical wards undergoing LC. The patients were primarily divided into two groups consisting of those undergoing LC and those converted to OC respectively. Parameters like gender, age, body mass index, associated complains, total leukocyte count (TLC) and levels of alkaline phosphatase (ALP) were assessed as potential risk factors for conversion.
Results: 50 patients were considered for this study. Results indicated that rate of conversion of LC to OC was found to be maximum for patients belonging to male gender, 31-40 years old, were obese, had previous history of upper abdominal surgery and had raised levels of TLC and ALP. Patients having multiple stones and contracted gall bladder also had a higher incidence of conversion to OC.
Conclusions: From results obtained in this study, it could be concluded that parameters like age, gender, obesity, history of upper abdominal surgery, raised levels of TLC and ALP, incidences of multiple stones and contracted gall bladder posed significant risk for LC and acted as predictors for conversion to OC.
References
Stanisic V, Milicevic M, Kocev N, Stojanovic M, Vlaovic D, Babic I, et al. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. Eur Rev Med Pharmacol Sci. 2014;18(8):1204-11.
Naik C, Kailas CT. Predicting difficulty in laparoscopic cholecystectomy by clinical, hematological and radiological evaluation. Int Surgery J. 2016;4(1):189-93.
Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005;19(7):905-9.
Kumar S, Tiwary S, Agrawal N, Prasanna G, Khanna R, Khanna A. Predictive factors for difficult surgery in laparoscopic cholecystectomy for chronic cholecystitis. The Int J Surg. 2008;6(2):254-8.
Beksac K, Turhan N, Karaagaoglu E, Abbasoglu O. Risk factors for conversion of laparoscopic cholecystectomy to open surgery: a new predictive statistical model. J Laparoendosc Adv Surg Tech. 2016;26(9):693-6.
Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, et al. Open versus laparoscopic cholecystectomy in acute cholecystitis: systematic review and meta-analysis. Int J Surg. 2015;18:196-204.
Bickel A, Hoffman RS, Loberant N, Weiss M, Eitan A. Timing of percutaneous cholecystostomy affects conversion rate of delayed laparoscopic cholecystectomy for severe acute cholecystitis. Surg Endosc. 2016;30(3):1028-33.
Sippey M, Grzybowski M, Manwaring ML, Kasten KR, Chapman WH, Pofahl WE, et al. Acute cholecystitis: risk factors for conversion to an open procedure. J Surg Res. 2015;199(2):357-61.
Gangemi A, Danilkowicz R, Bianco F, Masrur M, Giulianotti PC. Risk factors for open conversion in minimally invasive cholecystectomy. J Soc Laparoend Surg. 2017;21(4):e2017.00062.
Goyal V, Nagpal N, Gupta M, Kapoor R. A prospective study to predict the preoperative risk factors for conversion of laparoscopic to open cholecystectomy. J Contemp Med Surg Radiol. 2017;2(4):148-52.
Awan NA, Hamid F, Mir IN, Ahmad MM, Shah AA, Asimi A, et al. Factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy-institution based study. Int Surg J. 2017;5(1):132-7.
Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA, et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective UK database of 8820 patients. HPB. 2016;18(11):922-8.
Coffin SJ, Wrenn SM, Callas PW, Abu-Jaish W. Three decades later: investigating the rate of and risks for conversion from laparoscopic to open cholecystectomy. Surg Endosc. 2018;32(2):923-9.
Aziz H, Pandit V, Joseph B, Jie T, Ong E. Age and obesity are independent predictors of bile duct injuries in patients undergoing laparoscopic cholecystectomy. World J Surg. 2015;39(7):1804-8.
Calder CL, Ortega G, Vij A, Chawla K, Nnamdi-Emetarom C, Stephanie S, et al. Morbid obesity is an independent risk factor for postoperative renal dysfunction in young adults: a review of the American College of Surgeons National Surgical Quality Improvement Program database. The American J Surg. 2016;211(4):772-7.
Pandian TK, Ubl DS, Habermann EB, Moir CR, Ishitani MB. Obesity Increases operative time in children undergoing laparoscopic cholecystectomy. J Laparoendosc Adv Surg Tech. 2017;27(3):322-7.
Augustin T, Moslim MA, Brethauer S, Aminian A, Kroh M, Schneider E, et al. Obesity and its implications for morbidity and mortality after cholecystectomy: a matched NSQIP analysis. The Am J Surg. 2017;213(3):539-43.
Kidwai R, Pandit R, Issrani R, Prabhu N. Assessment of risk factors for conversion from difficult laparoscopic to open cholecystectomy-a hospital based prospective study. J Krishna Inst Med Sci. 2016;5(3):84-97.
Zhu B, Zhang Z, Wang Y, Gong K, Lu Y, Zhang N. Comparison of laparoscopic cholecystectomy for acute cholecystitis within and beyond 72 h of symptom onset during emergency admissions. World J Surg. 2012;36(11):2654-8.
Aryal RK, Gautam R. Retrospective assessment of laproscopic cholecystectomy versus open cholecystectomy in geriatric patients with acute cholecystitis: a comparative study. Int J Contemp Med Res. 2017;4(1):295-7.
Gill HS, Gupta A, Singh B. Evaluation of the role of various factors in conversion of laparoscopic cholecystectomy into open cholecystectomy. Int J Contemp Med Res. 2016;3:3031-5.
Husain A, Pathak S, Firdaus H. Assessment of operative predictors for difficulty in laproscopic cholecystectomy. Int J Contemp Med Res. 2016;3(4):1232-4.
Singh M, Singh K, Chawla IS. Laparoscopic cholecystectomy with and without drainage-a comparative clinical study. Int J Contemp Med Res. 2017;4(1):117-20.
Sahu SK, Agrawal A, Sachan PK. Intraoperative difficulties in laparoscopic cholecystectomy. J Surg. 2013;2:149-55.
