Difficult laparoscopic cholecystectomy versus conversion to open cholecystectomy: understanding and modern concepts

Abstract

Background: Cholecystectomy is the most common procedure performed on the biliary tract and the second most common major abdominal operation performed today. In this study we have assessed the value of clinical and ultrasonographic criteria in predicting intraoperative difficulties for patient undergoing laparoscopic Cholecystectomy (LC).Methods: The study was done on 50 patients of symptomatic cholelithiasis, requiring elective cholecystectomy, attending surgical OPD of People’s College of Medical Sciences and Research Centre, Bhopal, India from 31st September 2012 to 31st April 2014.Results: The mean age of the study population is 40.30years. Male to female ratio is1:4.5. The mean BMI of patients in study is 22.93 kg/m2. 9 patients had history of previous abdominal surgery. Specificity of ultrasound to predict the conversion to open procedure is 84.21%. Specificity of gallbladder wall thickness to predict the conversion to open cholecystectomy is 92.11%. Specificity of contracted gallbladder to predict the conversion to open cholecystectomy is 94.74%. Specificity of stone impaction at neck of gallbladder to predict the conversion to open cholecystectomy is 94.74%.Conclusions: In this study we have included 50 patients in which four clinical and four ultrasonographic parameters for predicting difficult laparoscopic cholecystectomy were analysed.