Analyzing the Factors for Pre-operative Prediction of Problematic Laparoscopic Cholecystectomy: A Cross-sectional Exploratory Study

Abstract

Background: Laparoscopic cholecystectomy is considered as the preferred treatment for symptomatic Cholelithiasis. Though laparoscopic cholecystectomies are considered a common surgical intervention, still 1-13% requires conversion to open cholecystectomy for various reasons. Pre-operative evaluation of such factors would be helpful to establish criteria that would assess the risk of conversion, hence the rationale for this study. Materials and Methods: A cross-sectional study conducted among patients (n=100) reporting with gall bladder disease and requiring cholecystectomy (aged 10-60 years) not having peritonitis, malignancy, pregnancy and/ or a compromised immune system were recruited in the study. Factors of difficult laparoscopic were assessed by Socio-demographic factors, Inspection and Palpation and USG findings (wall thickness, pericholecystic collection, impacted stone and post ERCP status). Following this, the patient was subjected to laparoscopic cholecystectomy and conversion was noted. SPSSv15.0 was utilized for statistical analysis (*p<0.05). Results: Study subjects with GB wall thickness >3mm, presence of pericholecystic fluid, appearance of WES sign, and subjects having multiple gall stones and/ or CBD stone had a significantly higher level of difficulty in gall bladder extraction, as well as higher chances of complicated bleeding. Overall, 13% subjects required a conversion from Laparoscopic Cholecystectomy to Open Cholecystectomy. Conclusion: Pre-operative prediction of difficult laparoscopic cholecystectomy can help the patient as well as the surgeon to prepare better for the intra operative risk and risk of conversion to open cholecystectomy.