Assessment of pre and intra-operative predictors for difficult laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy from the day of its introduction has aimed at improving the results of traditional surgical treatment and is regarded as gold standard treatment in cholecystitis. Objective: To assess various operative predictors for difficult laparoscopic cholecystectomy. Material and methods: The present prospective study was conducted over 100 patients with diagnosis of cholelithiasis confirmed by abdominal ultrasonography (USG). Surgical procedure was categorized postoperatively into easy, difficult and very difficult surgical procedure on the basis of time taken in minutes, bile/stone spillage, injury to duct and conversion to open cholecystectomy. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. Data so obtained was analyzed us-ing SPSS-22 data analysis software. Chi square test was used for statistical analysis with p<005 as significant value. Results: The present study found that obesity, co-morbid diseases, previous history of acute cholecystitis or pancreatitis, delayed surgery after 72 hour of gall bladder inflammation, increased thickness of gallbladder, multiple stones, size of calculi more than 1 cm are significant factors that result in difficult and very difficult surgical procedures. Conversion to open cholecystectomy was seen in 25 (25%) patients.