Clinicoradiological based risk assessment to predict difficult laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20194428Keywords:
Gallstone disease, Cholecystectomy, CholedocholithiasisAbstract
Background: The aim of the present study was to predict difficult laparoscopic cholecystectomy by clinical and radiological parameters.
Methods: All consecutive patients undergoing laparoscopic cholecystectomy and conversion to open surgery. Clinico-radiological laboratory parameters and imaging features were collected from patient. The study was categorized into Group 1 in which easy laparoscopic cholecystectomy case defined by total time taken for surgery less than 60 mins and no intra operative (surgical) and post-operative complications with postoperative hospital stay <48 hours. Group 2: Difficult laparoscopic cholecystectomy case defined by total time taken for surgery more than 60 min, intra operative and post-operative complications.
Results: In group 2, total number of patients who presented with more than one attack of cholecystitis were 36 (62.1%). Dyspepsia was common symptom in both groups. More number of patients with previous history of upper abdominal surgery went for difficult lap cholecystectomy. Total number of patients in both the groups were who had hypertension were 31.2% in comparison with non-hypertensives who were 68.8%. Majority of the patients in difficult case group had gall bladder wall thickness >4 mm. Majority of patients in difficult case group had calculi size >25 μm. History of previous attacks of cholecystitis, history of previous upper abdominal surgery, gall bladder wall thickness >4 mm and pericholecystic collection can be taken as predictors for difficult laparoscopic cholecystectomy.
Conclusions: Preoperative prediction of a difficult cholecystectomy and explaining advantages and disadvantages of conversion are of great help both to the patient who can plan his work and the surgeon who can also schedule his time and team accordingly.
References
Tendon R. Diseases of gallbladder and biliary tract. In: Shah SN, ed. API text book of Medicine. 2003;7th ed: 642-644.
Conference NC. Gallstones and laparoscopic cholecystectomy. JAMA. 1992;269:1018-24.
Sharma SK, Thapa PB, Pandey A, Kayestha B, Poudyal S. Predicting difficulties During laparoscopic cholecystectomy by preoperative ultrasound. Kathmandu Univ Med J. 2007;5(17):8-11.
Venneman NG, Buskens E, Besselink MG, Stads S, Go PM, Bosscha K, et al. Small gallstones are associated with increased risk of acute pancreatitis: potential benefits of prophylactic cholecystectomy?. Am J Gastroenterol. 2005;100:2540-50.
Kiewiet JJ, Leeuwenburgh MM, Bipat S, Bossuyt PM, Stoker J, Boermeester MA. A systematic review and meta-analysis of diagnostic performance of imaging in acute cholecystitis. Radiol. 2012;264:708-20.
Kalimi R, Gecelter GR, Caplin D, Brickman M, Tronco GT, Love C, et al. Diagnosis of acute cholecystitis: sensitivity of sonography, cholescintigraphy, and combined sonography-cholescintigraphy. J Am Coll Surg. 2001;193:609-13.
Yokoe M, Takada T, Strasberg SM, Solomkin JS, Mayumi T, Gomi H, et al. TG13 diagnostic criteria and severity grading of acute cholecystitis. J Hepatobiliary Pancreat Sci. 2013;20:35-46.
Soltes M, Radonak J. A risk score to predict the difficulty of elective laparoscopic cholecystectomy. Videosurg Mini-invasive Techniques. 2014;9(4):608-12.
Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167:35-41.
Bouarfa L, Schneider A, Feussner H, Navab N, Lemke HU, Jonker PP, et al. Prediction of intraoperative complexity from preoperative patient data for laparoscopic cholecystectomy. Artif Intell Med. 2011;52:169-76.
Thyagarajan M, Singh B, Thangasamy A, Rajasekar S. Risk factors influencing conversion of laparoscopic cholecystectomy to open cholecystectomy. Int Surg J. 2017;4(10): 3354-7.
Sippey M, Grzybowski M, Manwaring ML, Kasten KR, Chapman WH, Pofahl WE. Acute cholecystitis: risk factors for conversion to an open procedure. J Surg Res. 2015;199(2):357-61.
Arun PS, Rathnakar SK, Nagaraja AL. A study on clinical and radiological factors for predicting difficult laparoscopic cholecystectomy preoperatively. Int Surg J. 2017;4:3015-8.
Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg. 2009;71:198-201.
Kanaan SA, Murayama KM, Merriam LT, Dawes LG, Prystowsky JB, Rege RV. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res. 2002;106:20-4.
Kama NA, Kologlu M, Doganay M, Reis E, Atli M, Dolapci M. A risk score for conversion from laparoscopic to open cholecystectomy. Am J Surg. 2001;181:520-5.
Nachnani J, Supe A. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultra-sonographic parameters. Indian J Gastroenterol. 2005;24:16-8.
Nidoni R, Udachan TV, Sasnur P, Baloorkar R, Sindgikar V, Narasangi B. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. J Clin Diag Res. 2015;9(12):09-12.
