Effectiveness of preoperative scoring in predicting the difficult and extremely difficult laparoscopic cholecystectomy

Abstract

Background: To reduce the complications and conversion rate among the patients undergoing laparoscopic cholecystectomy, preoperative scores have been developed based upon the experience of surgeons and experience of the surgeries. Certain preoperative factors are thought to predict the difficult or extremely difficult laparoscopic cholecystectomy. Studies have shown the utility of the preoperative scoring to predict the difficult or extremely difficult laparoscopic cholecystectomy. To study the effectiveness of pre operative scoring in predicting the difficult and extremely difficult laparoscopic cholecystectomy.Methods: Present study was hospital based cross sectional diagnostic evaluation study carried out among 50 patients who were posted for laparoscopic cholecystectomy. The parameters which defined pre operative scoring as well as parameters which defined intra operative scoring were recorded and based on the total score, the difficulty level was assessed preoperatively and confirmed intraoperatively. The efficacy of preoperative scoring was determined by comparing it with intra operative scoring.Results: History of previous hospitalization, Palpable gall bladder, impacted stone and USG wall thickness/pericholecystic collection were significant preoperative factors. The overall diagnostic accuracy of preoperative scoring in predicting difficult laparoscopic cholecystectomy was 80%. Sensitivity was 94.44%, the specificity was 84.38%, positive predictive value was 77.27%, negative predictive value was 96.43%, likelihood ratio of a positive test was 6.044, and likelihood ratio of a negative test was 0.06584. Thus it can be said that the efficacy of preoperative scoring in predicting difficult laparoscopic cholecystectomy was very good.Conclusions: The efficacy of preoperative scoring in predicting difficult laparoscopic cholecystectomy was very good.