Assessment of preoperative patient factors in early prediction of difficult laparoscopic cholecystectomy: A single institution study

Abstract

Background: Laparoscopic cholecystectomy is the most common elective surgery performed by general surgeon. In certain situations lap cholecystectomy which is supposed to be simple and safe procedure becomes very difficult and unsafe. Therefore early prediction of difficulty level before elective surgeryis an important aspect so that patient can be counseled about the risks and outcomes.Methods: 80 cases of lap cholecystectomy operated by a single surgeon is included in the study. there are total 15 score from history, clinical, and sonological finding, they were evaluated and scored on the basis of scoring system of randhawa and Pujahari. Score up to 5 is defined as easy, 6-10 as difficult and 11-15 as very difficult.Result: the present study found that age, BMI, previous H/O hospitalization, palpable GB clinically, USG finding of increased GB wall thickness, impacted stone are significant factors that result in difficult and very difficult lap cholecystectomy. Conversion to open procedure was seen in 7.5% cases.Conclusion: the scoring system had a positive predictive falue of 83% with sensitivity of 94%.