Preoperative predictive factors of difficult laparoscopic cholecystectomy

Abstract

Background Laparoscopic cholecystectomy is a routine start-up procedure for any surgeon interested in the field of laparoscopy. However, one may encounter complex cases that may increase the risk of perioperative complications. It is crucial to identify these cases preoperatively for better surgical planning. Herein, we studied preoperative risk factors for difficult cholecystectomy procedures in our Egyptian tertiary care center. Methodology One hundred patients were enrolled in our study, and their cholecystectomy procedures were classified as easy, difficult, or very difficult based on two parameters; preoperative scoring system and intraoperative findings. Results There was a significant agreement between preoperative difficulty prediction score and intraoperative findings (k=0.858, P<0.001). Procedure difficulty was associated with patient hospitalization (P<0.001), previous supraumbilical surgeries (P=0.004), previous acute cholecystitis (P<0.001), previous jaundice (P=0.049), previous endoscopic biliary clearance (P=0.022), increased gallbladder wall thickness (P=0.001), and pericholecystic fluid collection (P=0.014). Conversion to the open approach was needed in 6 cases (6%). Age, sex, BMI, and impacted stone did not significantly impact procedure difficulty (P>0.05). Conclusion Multiple preoperative parameters have been significantly associated with the increased difficulty of the laparoscopic cholecystectomy procedure. Properly identifying these parameters and their inclusion into a scoring system would be greatly helpful in determining difficult cases during the preoperative period.