Intraoperative Predictors of Difficult Laparoscopic Cholecystectomy: AMU Scoring System
Mohammad S Akhtar, Parwez Alam, Yasir Alvi, Isna R Khan, Syed AA Rizvi, Mohammad H Raza
Cholecystectomy, Conversion to open and Calot\'s triangle, Laparoscopic, Operative scoring system
Citation Information :
Akhtar MS, Alam P, Alvi Y, Khan IR, Rizvi SA, Raza MH. Intraoperative Predictors of Difficult Laparoscopic Cholecystectomy: AMU Scoring System. World J Lap Surg 2021; 14 (2):114-118.
Introduction: With laparoscopy being the surgeon's first choice even in difficult cholecystectomy, a need to objectively grade intraoperative difficulty during laparoscopic cholecystectomy (LC) is gaining popularity. The study was done to design a scoring system to predict the difficult outcome during intraoperative LC.
Materials and methods: The study was done at the General Surgery Department in a tertiary level hospital among patients undergoing LC. The procedures that exceeded 70 minutes in duration and/or converted to open were considered the difficult LC. To develop the predictive score, an association of various factors with difficult cholecystectomy was identified by performing multiple logistic regression analysis, and receiver operating characteristic (ROC) curve was plotted to estimate the cutoff value for the scoring system.
Results: We recruited 200 patients in this study, out of which 85 had difficult cholecystectomy procedures. Among all intraoperative predictors, adhesions, gallbladder (GB) condition, Calot's triangle status and abnormality, and the presence of pericholecystic fluid were associated with a difficult LC. Based on the odds ratio, a new scoring system was designed with a score ranging from 0 to 25. The grading score was created as easy (0–5) and difficult (6 or above) based on the intraoperative factors. At a cutoff score of 6, this scoring system had a sensitivity and specificity of 87.1 and 88.7%, respectively.
Conclusion: This study demonstrates that an intraoperative scoring system can predict the difficult outcome of LC. This can help in minimizing the complication and conversion to open cholecystectomy, especially relevant for funds-limited settings like India.
Daradkeh SS, Suwan Z, Abukhalaf M. Preoperative ultrasonography and prediction of technical difficulties during laparoscopic cholecystectomy. World J Surg 1994;22(1):75–77. DOI: 10.1007/s002689900352.
Augustine A, Rao R, Vivek MAM. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Minim Access Surg 2014;10(2):62–67. DOI: 10.4103/0972-9941.129947.
Nachnani J, Supe A. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Ind J Gastro 2005;24:16–18. PMID: 15778520
Botaitis S, Polychronidis M, Pitiakoudis M, et al. Does gender affect laparoscopic cholecysytectomy. Surg Laprosc Endosc Percutan Tech 2008;18(2):157–161. DOI: 10.1097/SLE.0b013e318165c899.
Yol S, Kartal A, Vatansev C, et al. Sex as a factor in conversion from laparoscopic cholecystectomy to open surgery. JSLS 2006;10(3): 359–363. PMID: 17212896
Lal P, Agarwal PN, Malik VK, et al. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. J Soc Laparoendosc Surg 2002;6(1):59–63. PMID: 12002299
Husain A, Pathak S, Firdaus H. Assessment of operative predictors for difficulty in laproscopic cholecystectomy. Int J Contemp Med Res 2016;343:2393–2915. www.ijcmr.com
Lipman JM, Claridge JA, Haridas M, et al. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surgery 2007;142(4):556–565. DOI: 10.1016/j.surg.2007.07.010.
Akhtar MS, Alam P, Alvi Y, et al. A study of factors determining difficult surgery among patients undergoing laparoscopic cholecystectomy. Int Surg J 2019;6(9):3322–3327. DOI: 10.18203/2349-2902.isj20194073.
Bat O. The analysis of 146 patients with difficult laparoscopic cholecystectomy. Int J Clin Exp Med 2015;8(9):16127–16131. PMID: 26629124
Sahu SK, Agrawal A, Sachan PK. Intraoperative difficulties in laparoscopic cholecystectomy. Jurnalul Chir 2013;9(2):149–155. DOI: 10.7438/1584-9341-9-2-5.
Vivek MAKM, 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.
Malik A, Laghari AA, Talpur KAH, et al. Laparoscopic cholecystectomy in empyema of gall bladder: an experience at Liaquat University Hospital, Jamshoro, Pakistan. J Minim Access Surg 2007;3(2):52–56. DOI: 10.4103/0972-9941.33273.
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, 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.
Sugrue M, Sahebally SM, Ansaloni L, et al. Grading operative findings at laparoscopic cholecystectomy – a new scoring system. World J Emerg Surg 2015;10(1):14. DOI: 10.1186/s13017-015-0005-x.