Citation Information :
Kumar S, Saroj SK, More RS, Roy S, Dwivedi AN, Tiwary SK. Comparison of Intraoperative Findings with Ultrasonographic Scoring for Predicting Difficult Laparoscopic Cholecystectomy. World J Lap Surg 2021; 14 (3):166-170.
Introduction: Nowadays laparoscopic cholecystectomy is the gold standard treatment for symptomatic gallstone disease (GSD). Prediction of “difficult laparoscopic cholecystectomy” (DLC) may decrease morbidity and mortality as well as reduce the average cost of therapy. At present, very few scoring systems are available to predict the degree of difficulty during surgery.
Aim and objective: To compare the outcome of intraoperative findings with preoperating scoring to predict DLC.
Materials and methods: Two-hundred and nine patients were having GSD, operated by a single experienced surgeon in 2-year duration. Various preoperative predictors and intraoperative parameters of DLC were used for scoring and categorizing the difficulties, into (0–5), (6–10), and (10–15) as early, difficult, and very difficult surgical procedures, respectively.
Result: History of hospitalization for acute cholecystitis, overweight with BMI ≥27.5 kg/m2, palpable gallbladder, wall thickness >4 mm, and impacted stone were the most accurate preoperative predictors of DLC in the age-group of above 50 years. Statistically, a significant association was determined by comparing preoperative evaluation with the intraoperative outcome.
Conclusion: The preoperative and intraoperative scoring system can be helpful for assessment, experience, and decision-making. These scoring systems deserve a large-scale prospective study for validation.
Rao KS, Meghavathu GN, Rao GS, et al. Clinical study of gallstone disease and treatment options. J Evol Med Dent Sci 2015;4(79):13841–13848. DOI: 10.14260/jemds/2015/1972.
Thamil RS, Sinha P, Subramaniam PM, et al. A clinicopathological study of cholecystitis with special reference to the analysis of cholelithiasis. Int J Basic Med Sci 2011;2:68–72.
Kama NA, Doganay M, Dolapci M, et al. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 2001;15(9):965–968. DOI: 10.1007/s00464-001-0008-4.
Stanisic V, Milicevic M, Kocev N, et al. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. Eur Rev Med Pharmacol Sci 2014;18(8):1204–1211. PMID: 24817296.
Tosun A, Hancerliogullari KO, Serifoglu I, et al. Role of preoperative sonography in predicting conversion from laparoscopic cholecystectomy to open surgery. Eur J Radiol 2015;84(3):346–349. DOI: 10.1016/j.ejrad.2014.12.006.
Sakuramoto S, Sato S, Okuri T, et al. Preoperative evaluation to predict technical difficulties of laparoscopic cholecystectomy on the basis of histological inflammation findings on resected gallbladder. Am J Surg 2000;179(2):114–121. DOI: 10.1016/s0002-9610(00)00248-8.
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 G, Sharma PK, Gupta S, et al. Pre and per operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Int J Res Med Sci 2015;3(11):3342–3346. DOI: 10.18203/2320-6012.ijrms20151188.
Sahu SK, Agrawal A, Sachan PK. Intra-operative difficulties in laparoscopic cholecystectomy. Jurnalul de Chirurgic (Iasi) 2013;9(2):149–155. DOI: 10.7438/1584-9341-9-2-5.
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. PMID: 22856487.
Liu CL, Fan ST, Lai EC, et al. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg 1996;131(1):98–101. DOI: 10.1001/archsurg.1996.01430130100022.
Bhondave ST, Dash N, Thipse VJ, et al. Proposed diagnostic scoring system to predict difficult laparoscopic cholecystectomy. Journal of Medical Science And Clinical Research 2017;5(12):31682–31688. DOI: 10.18535/jmscr/v5i12.67.
Nidoni R, Udachan TV, Sasnur P, et al. Predicting difficult laparoscopic cholecystectomy based on clinicoradiological assessment. J Clin Diagn Res 2015;9(12):PC09–PC12. DOI: 10.7860/JCDR/2015/15593.6929.
Naik CG, Kailas C. Predicting difficulty in laparoscopic cholecystectomy by clinical, hematological and radiological evaluation. Int Surg J 2017;4(1):189–193. DOI: 10.18203/2349-2902.isj20164080.
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.
Chen RC, Liu MH, Tu HY, et al. The value of ultrasound measurement of gallbladder wall thickness in predicting laparoscopic operability prior to cholecystectomy. Clin Radiol 1995;50(8):570–572. DOI: 10.1016/s0009-9260(05)83195-2.
Tayeb M, Raza SA, Khan MR, et al. Conversion from laparoscopic to open cholecystectomy multivariate analysis of preoperative risk factors. J Postgrad Med 2005;51(1):17–20. PMID: 15793333.
Saleem AEA, Abdallah HA. Evaluation of preoperative predictive factors for difficult laparoscopic cholecystectomy in comparison with intraoperative parameters. Egypt J Surg 2018;37(4):504–511. DOI: 10.4103/ejs.ejs_66_18.
Kidwai R, Pandit R, Issrani R, et al. Assessment of risk factors for conversion from difficult laparoscopic to open cholecystectomy–a hospital based prospective study. J Krishna Inst Med Sci Univ 2016;5(3):84–97.