World Journal of Laparoscopic Surgery

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VOLUME 16 , ISSUE 3 ( September-December, 2023 ) > List of Articles

Original Article

Prediction of Encountering a Difficult Laparoscopic Cholecystectomy Using Clinical and Sonological Data

Jyotirmaya Nayak, Parikshita Dalai, Sujit Kumar Mohanty, Anil Kumar Behera, Ipsita Sahoo

Keywords : Calot's triangle, Cholecystectomy, Conversion, Difficult cholecystectomy

Citation Information : Nayak J, Dalai P, Mohanty SK, Behera AK, Sahoo I. Prediction of Encountering a Difficult Laparoscopic Cholecystectomy Using Clinical and Sonological Data. World J Lap Surg 2023; 16 (3):125-128.

DOI: 10.5005/jp-journals-10033-1582

License: CC BY-NC 4.0

Published Online: 12-01-2024

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Laparoscopic cholecystectomy is the GOLD STANDARD in the treatment of symptomatic cholelithiasis which has replaced the open cholecystectomy as a treatment option since Philip Mouret did the first lap cholecystectomy in the year 1987. Despite its feasibility and acceptability in some cases it becomes quite difficult to proceed laparoscopically and is converted to open cholecystectomy which is associated with increased risk of morbidity. If we can identify the preoperative factors associated with increased risk of conversion then one can optimize operative room efficiency and improve intraoperative planning to avoid surgery-related complications. Aim of the study: To identify factors that can predict difficult laparoscopic cholecystectomy using clinical and radiological parameters which can be assessed by the Randhwa and Pujahari scoring system. Materials and methods: This was a prospective observational study conducted from July 2021 to October 2022 at the Department of General Surgery, SCB Medical College, Cuttack. Total of 150 USG-diagnosed symptomatic cholelithiasis patients were included in the study. Total 9 parameters were taken into consideration to assess the preoperative difficulty. These parameters were: (1) Age (2) Sex (3) Previous history of hospitalization for acute cholecystitis (4) BMI (5) Abdominal scar (6) Palpable gall bladder (7) Gall bladder wall thickness (8) Pericholecystic collection (9) Impaction of stone. The statistical analysis was done by Chi-square test. Results: Out of 150 patients included in this study 90 (60%) were easy, 50 (33.3%) were difficult and 10 (6.66%) were very difficult which required conversion to open. The overall conversion rate was 6.66% which was within the acceptable conversion range, i.e. 1–13%.

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