Predicting difficulty in laparoscopic cholecystectomy preoperatively using modified Randhawa scoring system

Authors

  • Abhay M. Philip Department of General Surgery, Father Muller Medical College, Mangalore, Karnataka, India
  • Rakesh R. Anjarbeedu Department of General Surgery, Father Muller Medical College, Mangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2349-2902.isj20230491

Keywords:

Lap cholecystectomy, Prediction, Scoring

Abstract

Background: Laparoscopic cholecystectomy is a low-risk, minimally invasive operation and currently the standard for treatment of gallstone and gallbladder disease. Preoperative assessment of difficulty is required to prevent problems, ensure readiness, and ensure an effective course of surgery.

Methods: In our work, we attempted to use a modified grading system developed by Randhawa et al. to preoperatively predict a difficult laparoscopic cholecystectomy. Age, gender, illness duration, history of prior GB disease, BMI, abdominal scar location (infra or supraumbilical), palpable gallbladder, and sonographic findings (gall bladder wall thickness, pericholecystic collection, and impacted stone) were assessed in patients who had been diagnosed with GB stones and required LC. Depending on the individual surgeon's assessment, a procedure is rated as easy, difficult, or very difficult.

Results: On comparison of the test group difficulty level predicted with the gold standard of difficulty level intra op the test group has a sensitivity of 51.9 % and specificity of 100%. The test has a positive predictive value of 100% and Negative predictive value of 91.5%. The test and the gold standard agree on 154 out of 167 having a diagnostic accuracy of 92.21%. The Kappa value of 0.644 indicates very good agreement with a p value of <0.001. Area under the curve indicates 96.1% of the difficulty is predicted by the Total score and significant with p value of <0.001

Conclusions: The current modified Randhawa and Pujahari scoring method is useful and appropriate for forecasting operative outcome in laparoscopic cholecystectomy.

References

Raza M, Venkata RM. Predicting difficulty in laparoscopic cholecystectomy preoperatively using a scoring system. Int Surg J. 2019;6:957-62

Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg. 2009;71(4):198-201

Reinders JS, Gouma DJ, Heisterkamp J, Tromp E, van Ramshorst B, Boerma D. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography. HPB. 2013; 15(3):230-4.

Mann K, Belgaumkar AP, Singh S. Post-endoscopic retrograde cholangiography laparoscopic cholecystic-tomy: challenging but safe. JSLS. 2013; 17:371-5.

Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS. 1998;2:341e6.

Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. Surg Clin North Am. 2000;80:1127e45.

Khan IA, El-Tinay OE. Laparoscopic cholecystectomy for acute cholecystitis: can preoperative factors predict conversion? Saudi Med J. 2004;25(3):299e302.

Al-Mulhim AA. Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: A single surgeon experience. Saudi J Gastroenterol. 2008; 14(2):73-9.

Nidoni R, Udachan TV, Sasnur P, Baloorkar R, Sindgikar V, Narasangi B. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. JCDR. 2015;9(12): PC09.

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

Hussain A. Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparosc Endosc Percutan Tech. 2011;21(4):211e7.

Lein HH, Huang CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg 2002; 26:598e601.

Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184(3):254e8.

Simopoulos C, Polychronidis A, Botaitis S, Perente S, Pitiakoudis M. Laparoscopic cholecystectomy in obese patients. Obes Surg. 2005;15(2):243e6.

Vivek MA, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minimal Access Surg. 2014;10(2): 62-7.

Majeski J. Significance of preoperative ultrasound measurement of gallbladder wall thickness. Am Surg. 2007;73(9):926e9.

Carmody E, Arenson AM, Hanna S. Failed or difficult laparoscopic cholecystectomy: can preoperarive ultrasonography identify potential problems. J Clin Ultrasound. 1994;22(6):391e6.

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Published

2023-02-24

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Original Research Articles