Aim and objective: To validate the efficacy of proposed scoring system compared to the Randhawa scoring system in prediction of difficult laparoscopic cholecystectomy (LC) preoperatively.
Materials and methods: A prospective study was conducted including 102 patients who underwent LC for symptomatic cholelithiasis. Preoperatively a score was given to the patient according to both scoring systems. Final outcome was decided on intraoperative findings of operative time, adhesions, and bile spillage. Univariate and multivariate analyses of preoperative factors were done. Receiver operating characteristic (ROC) curves of both the scoring system were compared, and the results were reported as a difference in proportion (95% CI). p value <0.05 was considered as statistically significant.
Results: The specificity and positive predictive value of the modified scoring system were 92 and 95.1% which was higher than Randhawa scoring system, i.e., 76 and 87.5%. Area under ROC curve was also more in modified scoring system. Also, univariate analysis found age >50 years, history of hospitalization, previous endoscopic retrograde cholangiopancreatography, diabetes mellitus, palpable gallbladder, gallbladder wall thickness, and contracted gallbladder on ultrasound to be statistically significant factors.
Conclusion: The proposed modified scoring system significantly increases the specificity and positive predictive value of the Randhawa scoring system. This scoring system is easy to perform, require no additional investigation and can effectively categorize patient where LC will be difficult.
Clinical significance: The proposed scoring system can effectively predict difficult preoperatively which would help in better preoperative preparation by the surgical team for a difficult laparoscopic cholecystectomy. Patients can be optimally counseled preoperatively so that they are well prepared for various outcomes of the procedure.
Mc Kinley SK, Brunt LM, Schwaitzberg SD. Prevention of bile injury: the case for incorporating educational theories of expertise. Surg Endosc 2014;28(12):3385–3391. DOI: 10.1007/s00464-014-3605-8.
Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg 2009;71(4):198–201. DOI: 10.1007/s12262-009-0055-y.
Gupta N, Rajan G, Arora MP, et al. Validation of a scoring system to predict a difficult laparoscopic cholecystectomy. Int J Surg 2013;11(9):1002–1006. DOI: 10.1016/j.ijsu.2013.05.037.
Agrawal N, Singh S, Khichy S. Preoperative prediction of difficult laparoscopic cholecystectomy: a scoring method. Niger J Surg 2015;21(2):130–133. DOI: 10.4103/1117-6806.162567.
Beksac K, Turhan N, Karaagaoglu E, et al. Risk factors for conversion of laparoscopic cholecystectomy to open surgery: a new predictive statistical model. J Laparoendosc Adv Surg Tech A 2016;26(9):693–696. DOI: 10.1089/lap.2016.0008.
Vivek MA, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg 2014;10(2):62–67. DOI: 10.4103/0972-9941.129947.
Lee NW, Collins J, Britt R, et al. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy. Am Surg 2012;78(8):831–833. DOI: 10.1177/000313481207800815. PMID: 22856487.
Hussain A. Difﬁcult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparosc Endosc Percutan Tech 2011;21(4):211–217. DOI: 10.1097/SLE.0b013e318220f1b1.
Rothman JP, Burcharth J, Pommergaard HC, et al. Preoperative risk factors for conversion of laparoscopic cholecystectomy to open surgery – a systematic review and meta-analysis of observational studies. Dig Surg 2016;33(5):414–423. DOI: 10.1159/000445505.
Kanakala V, Borowski DW, Pellen MG, et al. Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg 2011;9(4):318–323. DOI: 10.1016/j.ijsu.2011.02.003.
Al-Mulhim AA. Male gender is not a risk factor for the outcome of laparoscopic cholecystectomy: a single surgeon experience. Saudi J Gastroenterol 2008;14(2):73–79. DOI: 10.4103/1319-3767.39622.
Raza M, Venkata RM. Predicting difficulty in laparoscopic cholecystectomy preoperatively using a scoring system. Int Surg J 2019;6(3):957–962. DOI: 10.18203/2349-2902.isj20190831.
Khetan AK, Yeola M. Preoperative prediction of difficult laparoscopic cholecystectomy using a scoring system. Int Surg J 2017;4(10):3388–3391. DOI: 10.18203/2349-2902.isj20174501.
Nachnani J, Supe A. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol 2005;24(1):16–18. PMID: 15778520.
Reinders JS, Gouma DJ, Heisterkamp J, et al. Laparoscopic cholecystectomy is more difficult after a previous endoscopic retrograde cholangiography. HPB (Oxford) 2013;15(3):230–234. DOI: 10.1111/j.1477-2574.2012.00582.x.
Aziret M, Karaman K, Ercan M, et al. Early laparoscopic cholecystectomy is associated with less risk of complications after the removal of common bile duct stones by endoscopic retrograde cholangiopancreatography. Turk J Gastroenterol 2019;30(4):336–344. DOI: 10.5152/tjg.2018.18272.
Aldaqal SM, Albaghdadi AT, Tashkandi HM, et al. Effect of diabetes mellitus on patients undergoing laparoscopic cholecystectomy: a comparative cross-sectional study. Life Sci J 2012;9(1):431–439.