Pre-operative prediction of difficult laparoscopic cholecystectomy

Authors

  • Ramesh Arumugam Department of General Surgery, Chennai Medical college Hospital & Research centre, Irungalur, Trich
  • Karthick Pandurengan Department of General Surgery, Chennai Medical college Hospital & Research centre, Irungalur, Trich

DOI:

https://doi.org/10.18203/2349-2902.isj20151083

Keywords:

Laparoscopic cholecystectomy, Gall bladder, Cholelithiasis, Difficult cholecystectomy

Abstract

Background:Laparoscopic cholecystectomy has become the gold standard in the treatment of cholelithiasis and is replacing open cholecystectomy. The rate of conversion from laparoscopic cholecystectomy to open cholecystectomy is 5 to 10%. Hence it is necessary to study the predictive factors for difficult laparoscopic cholecystectomy.

Methods: All patients are subjected to ultrasonographic evaluation. The patients confirmed by USG examination are evaluated with following factors: age, sex, BMI, h/o previous hospitalization, h/o previous abdominal surgeries, h/o acute cholecystitis / pancreatitis. Sonographic findings: GB wall thickness (>/< 3 mm), pericholecystic collection, number (solitary versus multiple) and liver parenchyma (Normal, fatty infiltration, liver fibrosis). Following evaluation the patients will be subjected to laparoscopic cholecystectomy and the following operative parameters : access to peritoneal cavity (easy/difficult), bleeding during surgery (normal/abnormal), gall bladder bed dissection (easy/difficult), injury to duct/artery, extraction of gall bladder (easy/difficult), or conversion to open surgery are noted.

Results:In the present study, BMI >32.5, history of cholecystitis, previous abdominal surgery, GB wall thickness>3mm, pericholecystic collection, multiple stones and liver fibrosis were significant predictors of difficult laparoscopic cholecystectomy.

Conclusions:In about 5 to 10% of the cases of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Therefore it is necessary to analyse the risk factors that predict difficult laparoscopic cholecystectomy.

References

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Published

2016-12-14

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Section

Original Research Articles