Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy

Authors

  • Prem R Sigdel Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Nirajan Subedi Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Suman Phuyal Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Ashik Pokharel Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Bikal Ghimire Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
  • Yogendra P Singh Department of GI and General Surgery, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, Nepal

Keywords:

Cholecystitis, difficult, laparoscopic cholecystectomy, open cholecystectomy, symptomatic gall stone disease

Abstract

Introduction
Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. It would be useful to have some reliable predictive factors for conversion in LC. Our aim is to predict difficult laparoscopic cholecystectomy preoperatively by using a scoring system.

Methods
A total of 136 patients were included. The parameters considered for this study were old age, male sex, history of hospitalization, obesity, abdominal surgery scar, palpable gall bladder, gall bladder wall thickness, pericholecystic collection and impacted stone.

Results
Among 136 cases, 70.6% were easy, 24.3% were difficult and 5.1% were very difficult intraoperatively. The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4mm and impacted stone were found statistically significant in predicting difficult LC. The preoperative scoring is statistically and clinically a good test for predicting the difficult LC (area under the curve = 0.824) with sensitivity of the test being 82.3% and specificity 72.7%. Conversion rate was 3.67%.

Conclusion
The factors like age >50 years, history of hospitalization for acute cholecystitis, previous abdominal surgery, palpable gall bladder, wall thickness >4 mm and impacted stone are the preoperative predictors of difficult LC.

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Published

2021-07-28

How to Cite

Sigdel, P. R., Subedi, N., Phuyal, S., Pokharel, A., Ghimire, B., & Singh, Y. P. (2021). Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy. Journal of Institute of Medicine Nepal, 42(3), 71–75. Retrieved from http://www.jiomnepal.com.np/index.php/jiomnepal/article/view/50

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