Pre-operative predictors of difficult laparoscopic cholecystectomy: a comparative study between two scoring systems

Abstract

Background: Laparoscopic cholecystectomy is considered as the gold standard in treating symptomatic gall bladder disease. It has now become the most common operation performed by general surgeons. At times laparoscopy becomes difficult and may need conversion to open cholecystectomy. Many scoring systems are developed to predict the difficulty of laparoscopic cholecystectomy pre operatively. Our study aims to determine factors predicting difficult cholecystectomy and validate 2 scoring systems i.e., risk score for conversion from laparoscopic to open cholecystectomy (RSCLO) vs. new scoring system (NSS).Methods: Patients presenting to Kempegowda institute of medical sciences from January 2014 to August 2015 with symptoms of gall stone disease were screened for cholelithiasis.100 patients undergoing laparoscopic cholecystectomy were randomly selected. Every patient was given pre-operative score, after applying their symptoms to the scoring system and these scores were compared with the intraoperative findings and post-operative outcome. Thereby, calculating the sensitivity and specificity of the scoring systems.Results: On univariate and multivariate logistic regression-BMI>27.5 kg/m2 (p=0.010), Palpable gallbladder (p=0.022), previous hospitalization for acute cholecystitis (p=0.15), Sonology: wall thickness>4 mm (p=0.0015), presence of pericholecystic edema, were found statistically significant. RSCLO system was better in predicting easy cholecystectomy i.e., low risk for conversion, while NSS was better in predicting difficult, very difficult cholecystectomies {converted cases}, its sensitivity being 100%.Conclusions: New scoring system can predict difficult cases reliably. Scoring patients preoperatively can decrease intra-op difficulties. Patients can pre-op be informed about possible risk of conversion to open cholecystectomy.