Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Abstract

Laparoscopic cholecystectomy become the treatment of choice for symptomatic gallstone disease. Difficult procedure may confront the surgeon, but these situations are often predictable based on a number of clinical and paraclinical factors. This study aimed to determine which clinical and paraclinical factors are associated with difficult laparoscopic cholecystectomy. Total of 405 patients with symptomatic gallstone disease, who underwent laparoscopic cholecystectomy between 1st Marc 2018 and 29th February 2020,in 22 May Hospital, Aden, were included in the study. Patient with gallbladder cancer or acalcular cholecystitis were excluded from the study. Relevant data which include clinical and paraclinical findings as well as operative findings were collected to a specially designed questionnaire form. Data analysis was done by SPSS version 17 software. Univariate analysis for categorical variables was done using Chi square or Fischer's exact test. Continuous data were tested for normal distribution and analyzed using Mann Whitney test. P- value <0.05 was considered statistically significant. Female preponderance (88.1%) was observed. Mean age was 42.6 ± 13.7. Difficult laparoscopic cholecystectomy found in 137 patients (33.8%). A statistically significant association were found between difficult laparoscopic cholecystectomy and gender (p-value <0.001), history of obstructive jaundice (p-value<0.001), previous endoscopic retrograde cholangio-pancreaticography (p-value <0.001), previous abdominal surgery (p-value =0.005), white blood cell count (p-value= 0.001), gallbladder wall thickness ≥ 4mm (p-value <0.001) , impacted stone in cystic duct (p-value <0.001), pericholecystic fluid collection (p-value <0.001), dilated common bile duct more than 7 mm (p-value =0.001), contracted gallbladder despite adequate fasting (p-value <0.001). Number of preoperative factors were identified, which have statistically significant association with difficult laparoscopic cholecystectomy. Knowledge of these factors by the surgeon before operation is imperative to make the necessary precautions before operation.