Abstract
Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively. Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment. Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883). Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.
Highlights
Laparoscopic cholecystectomy (LC) is one of the most common operation performed
Patients who had common bile duct stones, who had additional procedure to be done along with laparoscopic cholecystectomy, patients who had conversion or delay because of anesthetic complications and equipment failure, operations performed by trainee under supervision and those patients who were unwilling to give consent for the study were excluded from the study
Because there was no prediction of very difficult cases based on pre-operative scores and only 2 (2 %) cases were found to be very difficult, difficult and very difficult cases were combined for further analysis
Summary
Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. Difficult case results in prolonged operative time, bleeding, bile spillage, conversion and bile duct injury. This leads to unplanned prolonged hospital stay and increase in estimated cost to the patients and increased stress to the surgeon and pressure to complete the operative list.
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