Predictive factors and importance of Critical View of Safety in difficult elective laparoscopic cholecystectomy

Abstract

Knowing the surgical anatomy and related variations, revealing the factors that indicate difficult cholecystectomy, knowing and applying various safe surgical cholecystectomy techniques and guidelines recommended to prevent injuries can prevent complications. This study, it is aimed to evaluate the preoperative factors that will predict difficult elective cholecystectomy. We retrospectively analyzed the data of patients treated for cholelithiasis by an experienced hepatobiliary surgeon or under his supervision between March 2018 and March 2020. Clinical, laboratory, and imaging data obtained from patients' files were evaluated. According to the Modified Nassar Scale (MNS), 140 (79.5%) patients were considered grade 1-2 (easy) and 36 (20.5%) grade 3-5 (difficult) patients within the framework of intraoperative findings. Critical View of Safety was successfully performed in 170 (96.6%) of the patients. Converting laparoscopic cholecystectomy to open was performed in two (1.1%) patients who had an MNS of 4 and 5. The most common comorbidity was hypertension. Male gender, previous cholecystitis and ERCP, and increased gall bladder wall thickness from preoperative USG findings are independent risk factors for difficult cholecystectomy in patients scheduled for laparoscopic cholecystectomy. In addition, it should be kept in mind that LC can be difficult in patients with hypertension and coronary artery disease.