Factors predicting difficult laparoscopic cholecystectomy: A single-institution experience

Abstract

Introduction: Cholelithiasis is the most common biliary pathology, with prevalence of 10-15%. In 1992, National Institute of Health consensus development stated that laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones and it is the treatment of choice for cholelithiasis. This study is undertaken to determine the predictive factors for difficult laparoscopic cholecystectomy. Methodology: A prospective open-labeled study was carried out at Padmashree Vasant Dada Patil, Government Hospital Sangli, a tertiary center and teaching hospital in Western Maharashtra that is attached to Government Medical College, Miraj. All patients presenting with upper abdominal pain, or vomiting or dyspepsia or jaundice from January 1, 2011 to December 31, 2013 were screened for cholelithiasis. Ninety-nine cases diagnosed with cholecystitis following exclusion criteria and undergoing laparoscopic cholecystectomy were considered for the study. They were evaluated with following risk factors: age >50 years, male gender, body mass index (BMI) 25.1-27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each risk factor was given a score preoperatively. The total score up to five predicted easy, 6-10 difficult and >10 very difficult. Statistical analysis was performed using Fischer's Test for qualitative data and unpaired t-test for quantitative data. Results: BMI >27.5 history of prior hospitalization, palpable gallbladder, impacted stone and pericholecystic collection are significant predictors of difficult laparoscopic cholecystectomy. Conclusion: The proposed scoring system had a positive prediction value for easy prediction of 94.05% and for difficult prediction of 100%.