World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 2 ( May-August, 2022 ) > List of Articles

Original Article

Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy

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.

DOI: 10.5005/jp-journals-10033-1532

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.

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  1. Behari A, Kapoor VK. Asymptomatic gallstones (AsGS) – to treat or not to? Indian J Surg 2012;74(1): 4–12. DOI: 10.1007/s12262-011-0376-5.
  2. Aerts R, Penninck F. The burden of gallstone disease in Europe. Aliment Pharmacol Ther 2003;18 (Suppl 3):49–53. DOI: 10.1046/j.0953-0673.2003.01721.x.
  3. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012;6(2):172–187. DOI: 10.5009/gnl.2012.6.2.172.
  4. Khuroo MS, Mahajan R, Zargar SA, et al. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989;30(2): 201–205. DOI: 10.1136/gut.30.2.201.
  5. Unisa S, Jagannath P, Dhir V, et al. Population-based study to estimate prevalence & determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB 2011;13(2):117–125. DOI: 10.1111/j.1477-2574.2010.00255.x.
  6. Gaharwar A, Mishra SR, Kumar V. Histomorphological spectra of gall bladder specimens after cholecystectomy in benign diseases. Int J Anat Appl Physiol 2016;2(5): 49–56. DOI: 10.19070/2572-7451-160008.
  7. Mathur AV. Need for prophylactic cholecystectomy in silent gall stones in North India. Indian J Surg Oncol 2015;6(3):251–255. DOI: 10.1007/s13193-015-0418-8.
  8. Sangwan MK, Sangwan V, Garg MK, et al. Gallstone disease menacing rural population in north India: a retrospective study of 576 cases in a rural hospital. Int Surg J 2015;2(4):487–491. DOI: 10.18203/2349-2902.isj20150916.
  9. Sachdeva S, Khan Z, Ansari MA, et al. Lifestyle and gallstone disease: scope for primary prevention. Indian J Community Med 2011;36(4):263–267. DOI: 10.4103/0970-0218.91327.
  10. Laura M, Eldon A. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012;6(2):172–187. DOI: 10.5009/gnl.2012.6.2.172.
  11. Vivek MK, 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.
  12. Jaskiran S, Ashwini K. Indian J Surg 2009;71:198–201. DOI: 10.1007/s12262-009-0055-y.
  13. Gupta N, Ranjan G, Arora MP, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg 2013;11(9):1002–1006. DOI: 10.1016/j.ijsu.2013.05.037.
  14. Dakhale GN, Hiware SK, Shinde AT, et al. Basic biostatistics for post-graduate students. Indian J Pharmacol 2012;44(4):435–442. DOI: 10.4103/0253-7613.99297.
  15. Sunder Rao PSS, Richard J. An Introduction to Biostatistics. A Manual for Students in Health Sciences, New Delhi: Prentice hall of India. 4th edition. 2006;86–160.
  16. Elenbaas RM, Elenbaas JK, Cuddy PG. Evaluating the medical literature. Part II: statistical analysis. Ann Emerg Med 1983;12(10):610–620. DOI: 10.1016/s0196-0644(83)80205-4.
  17. Litynski GS. Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time. JSLS 1998;2(4):341–346. PMID: 10036125.
  18. Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. Surg Clin North Am 2000;80(4):1127–1149. DOI: 10.1016/s0039-6109(05)70217-6.
  19. Khan IA, El-Tinay OE. Laparoscopic cholecystectomy for acute cholecystitis: can preoperative factors predict conversion? Saudi Med J 2004;25(3):299–302. PMID: 15048165.
  20. Oymaci E, Ucar AD, Aydogan S, et al. Evaluation of affecting factors for conversion to open cholecystectomy in acute cholecystitis. Prz Gastroenterol 2014;9(6):336–341. DOI:10.5114/pg.2014.45491.
  21. Jethwani U, Singh GJ, Mohil RS, et al. Prediction of difficulty & conversion in laparoscopic cholecystectomy. OA Minim Invasive Surg 2013;1(1):2. DOI: 10.13172/2054-2666-1-1-650.
  22. 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.
  23. Dhanke PS, Ugane SP. Factors predicting difficult laparoscopic cholecystectomy: a single-institution experience. Int J Stud Res 2014;4(1):3–7. DOI: 10.4103/2230-7095.137612.
  24. 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.
  25. Bakos E, Bakos M, Dubaj M, et al. Conversions in laparoscopic cholecystectomy. Bratisl Lek Listy 2008;109(7):317–319. PMID: 18792487.
  26. Ishizaki Y, Miwa K, Yoshimoto J, et al. Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004. Br J Surg 2006;93(8):987–991. DOI: 10.1002/bjs.5406.
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