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VOLUME 15 , ISSUE 2 ( May-August, 2022 ) > List of Articles
Sajay Reddy, PN Sreeramulu
Keywords : Cholecystectomy, Laparoscopic, Predictive factors, Preoperative, Scoring system
Citation Information : Reddy S, Sreeramulu P. Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy. World J Lap Surg 2022; 15 (2):131-139.
License: CC BY-NC 4.0
Published Online: 16-08-2022
Copyright Statement: Copyright © 2022; The Author(s).
Background: Laparoscopic cholecystectomy (LC) is considered as the most common laparoscopic procedure in the world and is now the Gold standard treatment for cholelithiasis. Gallstone disease (cholelithiasis) has increasingly become one of the major causes of abdominal pain and discomfort in the developing world. Its occurrence has been found to be high (7.4%) in the adult population in the cities of Chandigarh and New Delhi in North India, which is one of the highest in the world. Gallstones are more common in the female population (61%) as compared to males (39%). The most common age-group affected is 45–60 years (38.5%) among females and above 60 years in males (20.8%). A relatively higher prevalence of 39% among males when compared to reports from past studies indicates a significant shift in the pattern of prevalence of gallstone disease. Many risk factors for cholelithiasis cannot be modifiable, such as ethnic background, advancing age, female gender, family history or genetics. The modifiable risks for cholelithiasis are obesity, quick weight loss, an idle lifestyle. A rising epidemic of obesity and the metabolic syndrome predicts an escalation in gallstones. Frequent risk factors for biliary sludge include pregnancy, drugs like ceftriaxone, octreotide, and thiazide diuretics, total parenteral nutrition, and fasting. Diseases like cirrhosis, chronic hemolysis, and Crohn's disease are a few risk factors for black pigment stones. In our hospital setup (RL Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka), in the Department of Surgery, a total of 166 cholecystectomies were performed in the period between October 2015 and September 2018. In total, 134 of these cases were elective laparoscopic cholecystectomy and twenty five of them were elective open cholecystectomies. There were a total of 7 cases that had to be changed from laparoscopic to open procedure due to intraoperative difficulty involved. That gives us a conversion rate of 4.96% over the past 3 years in our hospital setup. Preoperative prediction for the likelihood of conversion to open or difficulty of operation is an important aspect of planning laparoscopic surgery as the prevalence of gallbladder disease is increasing in India, and laparoscopic surgery is becoming more accessible. Arogya Karnataka Scheme, which can be used in our hospital setup, has laparoscopic cholecystectomy as one of its schemes for impoverished patients bringing the chance of laparoscopic surgery to the public. As a result, the number of laparoscopic cholecystectomies as a whole as well as the risk of conversion increases, making the need for study all the more important. Aims and objectives: (1) To validate that a scoring system based on history, physical examination, and ultrasonographic findings is a reliable predictor of the difficulty of laparoscopic cholecystectomy. (2) To help in choosing a favorable treatment modality depending on the score. (3) To help predict the duration of hospital stay and postoperative complications with the help of this system. Methods: A prospective and comparative study, considering 70 patients admitted and undergoing laparoscopic cholecystectomy at RL Jalappa Hospital and Research Center attached to Sri Devaraj Urs Academy of Higher Education Tamaka, Kolar, during the period of November 2018 and 10th October 2020. Results: The preoperative scoring system devised is excellent at predicting the intraoperative difficulties encountered by surgeons while performing laparoscopic cholecystectomy with a sensitivity of 88.9% and a specificity of 92.3%. The scoring system also predicted intraoperative complications with a specificity of 94.2% when the score is >7. There was also a very strong correlation between the preoperative score and the duration of surgery (r = 0.752, p <0.001) and also between the preoperative score and the duration of hospital stay (r = 0.788, p <0.001). Conclusion: Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. I would conclude that the scoring system evaluated in our study can be used to predict difficult cases.