Pre-operative factors for predicting a difficult laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20183451Keywords:
BMI, Cholecystectomy, Difficult, LaparoscopicAbstract
Background: Laparoscopic cholecystectomy is a very safe procedure yet there are instances where serious complications can be avoided and better managed if the surgeon is forewarned or prepared in advance for them. So, a need is felt to identify pre-operative parameters for anticipating a difficult cholecystectomy.
Methods: This study was carried over a period of two years (2007- 2009). Patients having symptomatic cholelithiasis willing to undergo laparoscopic cholecystectomy were enrolled in the study. The following pre-operative parameters were evaluated in the study: age, sex, body mass index, history of previous abdominal surgery, history of acute cholecystitis, history of biliary colic, palpable lump in right hypochondrium, experience of the surgeon and abdominal ultrasonogram (following parameters were noted increased gallbladder wall thickness, number of stones, size of largest stone and its location).
Results: Acute cholecystitis, palpable gall bladder, increased gallbladder wall thickness, biliary colic, gall stones >2 cm in size, gall stone impacted at gallbladder neck and BMI >30 kg/m2 had a significant p-value in a difficult laparoscopic cholecystectomy.
Conclusions: Further research is needed to formulate a score based on the variables mentioned above to predict a difficult laparoscopic cholecystectomy and hence letting the surgeon be better prepared for any eventualities that he encounters whilst performing laparoscopic cholecystectomy.
References
Singh K, Ohri A. Difficult laparoscopic cholecystectomy: A large series from north India. Indian J Surg. 2006;68:205-8.
Tendon R. Diseases of gall bladder and biliary tract. In: Shah SN, eds. API Text Book of Medicine. 7th Ed. Jaypee Brothers Medical Publishers; 2003:642-4.
Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH. Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg. 2006;30:1698-704.
Zinner MJ, Ashley SW. Maingots abdominal Operations. Tata McGraw - Hill Education; 2013.
Vivek MAKM, Augustine AJ, Rao R. A comprehensive predicting scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg. 2014;10(2):62-7.
Randhawa JS, Pujahari Ak. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg. 2009:71:198-201.
Jansen S, Caplehorn J. Preoperative ultrasound to predict conversions in laparoscopic cholecystectomy. Surg laparosc Endosc. 1997;7:121-3.
Gupta AK, Shiwach N, Gupta S, Gupta S, Goel A, Bhagat TS. Predicting difficult laparoscopic cholecystectomy. Int Surg J. 2018;5(3):1094-9.
Schrenk P, Woisetschlager R. Laparoscopic cholecystectomy. Surg Endosc. 1995;9:25.
Kanaan SA, Murayama KM, Merriam LT, Dawes LG, Rege RV, Joehl RJ. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res. 2002;106(1):20-4.
Kama NA, Kolongue M, Doganay M, Reis E, Atle M, Dolapiu M. Risk score conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001;181:520-5.
Fried GM, Barkun JS, Sigman HH, Joseph L, Uas D, Garzon J, et al. Factors determining conversion to laparotomy in patient undergoing laparoscopic choleystectomy. Am J Surg. 1994;167:35-41.
Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS. 2002;6(1):59.
