Vol. 4, Issue 12 (2018)
Evaluating clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion: A prospective study
Author(s): Dr. UC Singh, Dr. Sandesh Kumar Shrivastava
Abstract: Background: Forecast of a difficult laparoscopic cholecystectomy (LC) can help the surgeon as well as the patient to prepare better for any intra-operative risk and its effective management. Objectives: To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion Materials and Methods: Hundred patients of gallstone disease undergoing LC were studied from September 2013 to July 2014 at Department of Surgery, BRD Medical College Gorakhpur. All the patients underwent detailed pre-operative history, clinical examination, lab investigations and transabdominal sonography. The study group was subjected to LC using the general anesthesia. Per-operative degree of difficulty was evaluated depending on objective variables which included presence of adhesions at Calot’s triangle and between omentum and gall bladder, obvious injury to gall bladder, biliary ducts, bowel, diaphragm or other abdominal viscera, stone/biliary spillage, Injury to vessels, need of conversion to open procedure and post-operative complications in the early post-operative period arising as a result of intra-operative difficulty e.g. biliary fistula, bilioma, biliary peritonitis and bowel injury unmasking after surgery. Results: Female (n=82) preponderance was observed. Mean age and BMI was 38.60±11.62 years and 27.29±3.59 kg/m2 respectively. Incidence rate of difficult LC was 34% whereas conversion rate to open cholecystectomy was 11%.Rate of difficult LC was significantly more in patients with history of previous abdominal surgery (n=34, p<0.001), tenderness in right hypochondrium (n=31, p=0.003) and thickening of GB (n=19, p <0.001) whereas Conversion to open procedure was significantly high in patients with thickening of GB (n=19, p=0.001) and distended or contracted gallbladder (n=18, p=0.001). Most common intra-operative findings which made the procedure difficult was Dense adhesions at Calot's triangle (n=32). Most common reason for Conversion to Open Procedure was Stone/biliary spillage (36.4%). Conclusion: BMI, history of previous abdominal surgery, tenderness in right hypochondrium and thickening of gallbladder are the significant predictive factors for difficult LC whereas conversion to open procedure was high in patients with thickening of gallbladder and gallbladder contracted.