DOI: http://dx.doi.org/10.18203/2349-2902.isj20210357

Determination of predictive factors for difficult laparoscopic cholecystectomy

Sameer Bhattarai, Ishory Bhusal

Abstract


Background: Cholelithiasis is the most common biliary pathology, with a prevalence of 10 to 15%. It is symptomatic in approximately 1 to 2% of patients. In about 5 to 10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Laparoscopic cholecystectomy (LC) may be rendered difficult by various problems encountered during surgery. The objective of this study was to predict difficulty of LC before surgery using the clinical and ultrasonographic criteria.

Methods: The present study comprised of 45 cases admitted to National Medical College Teaching Hospital (NMCTH), Birgunj (Nepal) for a period of 12 months from 1st August 2013 to 30th September 2014. The cases confirmed by Ultrasonography were evaluated with following risk factors: age >50 years, male sex, BMI 25.1 to 27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gall bladder wall thickening, impacted stone, pericholecystic collection and presence of adhesions. Each risk factor was given a score. The total score up to 5 predicted easy, 6 to 10 difficult and more than 10 very difficult.

Results: The highest age incidence of Cholelithiasis was in the 2nd to 4th decade and was more common in females. Ultrasonography detected gallbladder stones in all patients, wall thickening in 15 and pericholecystic collection in 8. BMI >27.5 presence of adhesions, male sex and pericholecystic collection were significant predictors of difficult laparoscopic cholecystectomy.

Conclusions: Numerous clinical, radiological and pre-operative features make LC sometimes difficult. Early determination of these predictive factors decreases the difficulty that we will be facing with LC.


Keywords


Cholelithiasis, Laparoscopic cholecystectomy

Full Text:

PDF

References


Shaffer EA. Epidemiology of gallbladder stone disease. Best Prac Res Clin Gastroenterol. 2006;20(6):981-96.

Csikesz N, Ricciardi R, Tseng JF, Shah SA. Current status of surgical management of acute cholecystitis in the United States. World J Surg. 2008;32(10):2230-6.

Shammout R, Al Habbal R, Rayya F. Porta Hepatis Injury during Laparoscopic Cholecystectomy. Case Reports Gastroenterol. 2020;14(1):234-41.

Shamiyeh A, Danis J, Wayand W, Zehetner J. A 14-year analysis of laparoscopic cholecystectomy: conversion-when and why? Surg Laparos Endo Percut Tech. 2007;17(4):271-6.

Vollmer CM, Callery MP. Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterol. 2007;133(3):1039-41.

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. Artificial Intelligence Med. 2011;52(3):169-76.

Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis A. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endo Other Interven Tech. 2005;19(7):905-9.

Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for acute cholecystitis: prospective trial. World J Surg. 1997;21(5):540-5.

Eldar S, Sabo E, Nash E, Abrahamson J, Matter I. Laparoscopic cholecystectomy for the various types of gallbladder inflammation: a prospective trial. Surg Laparos Endos. 1998;8(3):200-7.

Lipman JM, Claridge JA, Haridas M, Martin MD, Yao DC, Grimes KL, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surg. 2007;142(4):556-65.

Krähenbühl L, Sclabas G, Wente MN, Schäfer M, Schlumpf R, Büchler MW. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg. 2001;25(10):1325-30.

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.

Lim K, Ibrahim S, Tan N, Lim S, Tay K. Risk factors for conversion to open surgery in patients with acute cholecystitis undergoing interval laparoscopic cholecystectomy. Annals-Acad Med Singapore. 2007;36(8):631.

Hermann R. Biliary disease in the aging patients. New York. 1983:227-32.

Bhattacharya D, Senapati PS, Hurle R, Ammori BJ. Urgent versus interval laparoscopic cholecystectomy for acute cholecystitis: a comparative study. J Hepato‐Biliary‐Panc Surg. 2002;9(5):538-42.

Motiwala HG. Operative Technique Cholecystectomy. A Study Of. 1991;250.

Jethwani U, Singh G, Mohil R, Kandwal V, Razdan S, Chouhan J, et al. Prediction of difficulty and conversion in laparoscopic cholecystectomy. OA Mini Invas Surg. 2013;1(1):2.

Ganey JB, Johnson Jr PA, Prillaman PE, McSwain GR. Cholecystectomy: clinical experience with a large series. Amer J Surg. 1986;151(3):352-7.

Sabiston DC. Sabiston textbook of surgery: the biological basis of modern surgical practice; 2001.

Gupta N, Ranjan G, Arora M, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Intern J Surg. 2013;11(9):1002-6.

Yetkin G, Uludag M, Citgez B, Akgun I, Karakoc S. Predictive factors for conversion of laparoscopic cholecystectomy in patients with acute cholecystitis. Bratisl Lek Listy. 2009;110(11):688-91.

Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Ame J Surg. 2002;184(3):254-8.

Haziq Ul Yaqin H. Chronic Cholecystitis. International Surgery; 1970.

Sharma M. Towards a safer cholecystectomy-The fundus to porta approach. Indian J Surg. 1997;59(4):141-5.

Gabriel R, Kumar S, Shrestha A. Evaluation of predictive factors for conversion of laparoscopic cholecystectomy. Kathmandu University Med J. 2009;7(1):26-30.

Atmaram D, Lakshman K. Predictive factors for conversion of laparoscopic cholecystectomy. Ind J Surg. 2011;73(6):423-6.

Capizzi FD, Fogli L, Brulatti M, Boschi S, Di Domenico M, Papa V, et al. Conversion rate in laparoscopic cholecystectomy: evolution from 1993 and current state. J laparoendo Advan Surg Tech. 2003;13(2):89-91.

Schäfer M, Krähenbühl L, Büchler MW. Predictive factors for the type of surgery in acute cholecystitis. Amer J Surg. 2001;182(3):291-7.

Vivek MAKM, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Mini Acc Surg. 2014;10(2):62.