Evaluation of difficulties in laparoscopic cholecystectomy

Abstract

Introduction. For decades, laparoscopic cholecystectomy has been the gold standard in surgical treatment of patients with cholelithiasis all over the world. The main advantage of this approach is that it is a minimally invasive procedure for patients. Although this method is a routine in our country, there are certain cases where the presumed outcome of minimally invasive procedure is not achieved, and the surgery is converted to open surgery, or a subsequent laparoscopic surgery is performed, in order to deal with the complications. The aim of this study was to establish if it was possible to create a model for preoperative prediction of difficult laparoscopic cholecystectomies. Material and Methods. Two groups of patients were analyzed. Group A included patients with cholelithiasis who were studied in order to determine parameters associated with difficult laparoscopic cholecystectomies. Out of 16 analyzed parameters, 8 showed significant correlation with difficult laparoscopic cholecystectomies. Based on these parameters, a prediction model was established, consisting of five groups: I - easy (score 1), II - laparoscopic cholecystectomy with mild difficulties (score 2), III - laparoscopic cholecystectomy with major difficulties (score 3), IV - difficult (score 4), V - conversion to open surgery is expected (score 5). This model was preoperatively applied in patients with cholelithiasis included in group B. Results. The overall predictability of the model was 82%. The greatest prediction accuracy was achieved in groups II and III (98.3% and 100%, respectively). Conversion to open cholecystectomy was predicted in 76% of patients. Conclusion. Based on certain preoperative parameters it is possible to establish a model to predict a difficult laparoscopic cholecystectomy.