Abstract
It is important to establish the difficulty of a cholecystectomy preoperatively to improve the outcomes. There are multiple risk factors for a difficult cholecystectomy that may depend on the patient, the disease, or extrinsic factors. The aim of this study is to evaluate the predictive capacity of a difficult cholecystectomy with a preoperative scale. A diagnostic trial study was designed to evaluate the performance of a scale to predict the difficulty of laparoscopic cholecystectomy, considering as a reference standard the intraoperative findings evaluated according to an intraoperative difficulty scale. A ROC curve was performed and used to estimate predictive value of the preoperative score to predict the difficulty of a cholecystectomy preoperatively. The ROC curve shows an area of 0.88 under the curve. The calculated ideal cutoff was 8, with a sensitivity, specificity, positive predictive value and negative predictive value of 75.15%, 88.31%, 87.32 and 76.83%, respectively. It was demonstrated that, as the difficulty predicted by the preoperative scale increases, the rate of conversion to open procedure, the rate of subtotal cholecystectomies, the rate of complication and the rate of a critical view of safety failed increase. We suggest implementing the preoperative scale in all patients who are planning laparoscopic cholecystectomy, considering it a simple and easy tool to perform. This to inform the patient, organize the surgery schedule, select personnel, request support and have adequate pre-operative planning.Graphical abstract
Highlights
Laparoscopic cholecystectomy since its first description in 1985 has become the reference standard for the treatment of benign biliary disease
We find multiple scales to predict a difficult cholecystectomy; most of these are based on the conversion rate or the surgical times, which can vary according to the experience of the surgeon [3, 4, 11, 12]
The aim of this study is to evaluate the predictive capacity of a difficult cholecystectomy with a preoperative scale described by Nassar at the Hospital Universitario Mayor Méderi in Bogotá, Colombia 2020
Summary
Laparoscopic cholecystectomy since its first description in 1985 has become the reference standard for the treatment of benign biliary disease. Multiple factors that may influence the difficulty of a cholecystectomy have been described, which may be related to the patient, such as age, sex, anatomical variations, previous surgeries, obesity, or may be related to pathologies such as severe inflammation or impacted stones, external factors such as failure of inappropriate equipment or equipment may influence [1, 3,4,5,6,7] The evaluation of this difficulty can vary between the perception of a surgeon and another, the importance of using a single intraoperative difficulty scale, where intraoperative findings are described. Intraoperative findings are standardized with the help of one of these scales [10]
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