Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Abstract

Aim: To evaluate the factors for prediction of difficult laparoscopic cholecystectomy preoperatively. Methods: A Prospective Observational Study conducted at Surgical Unit II, Ghulam Muhammad Mahar Medical College Hospital Sukkur, from February 2020 to January 2021. Data was collected for 580 patients. All the patients fulfilling inclusion criteria were evaluated with following factors: age, gender, BMI, h/o previous GB disease, comorbids, h/o previous abdominal surgery, tender RHC, palpable gallbladder, ultrasonographic findings of gall bladder wall thickness, pericholecystic fluid collection & stone impaction at neck of gall bladder. Patients were assumed to be difficult on presence of one or more of above mentioned risk factors .laparoscopic cholecystectomy was performed by an experienced laparocopic surgeon. Peroperative findings and operative time was noted. Cases were considered difficult if operative time was >60 minutes or if the case was converted to open. All the information was recorded on predesigned proforma. Results: Age ranged from 23 to 70 years (mean age = 46.37 years). 456 patients were female while 124 patients were male. Majority of patients in our study (n=390) had normal BMI(BMI=18.5-24.9)and next majority (n=132) belonged to overweight group(BMI=25-29.9) . On inquiry, 93 patients had history of previous gall bladder disease in form of cholecystitis. Out of 580 patients, 161 patients had one or more comorbids. 39 out of 580 patients had history of previous abdominal surgery. 78 patients had tender right hypochonrium. 62 patients had palpable gall bladder. On ultrasound 73 patients had gall bladder wall thickness >4mm. In 39 patients pericholecystic fluid collection was found. In 33 patients, stone was impacted at the neck of gall bladder. 161 patients were preoperatively labeled as difficult. All the patients underwent laparoscopic cholecystectomy. Mean operative time was 42.56 minutes. 512 patients underwent uneventful laparoscopic cholecystectomy, in 68 patients difficulty was encountered 11 patients were converted to open procedure. Conclusion: We conclude that a careful insight in certain factors can predict the difficult laparoscopic cholecystectomy preoperatively. It acts as an important eye opener for surgeons to get an idea of the potential difficulty to be faced in that particular patient. Keywords: Laparoscopic cholecystectomy, Preoperative, Gall stones, Difficulty