Preoperative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic criteria
Dasuk Disiar, J T Sankpal, A H Bhandarwar, Ankush Wankhede, Harshvardhan Ashok Bansode
Aim: To assess preoperative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic criteria. Material and Methods: Using clinical and ultrasonographic criteria, a hospital-based prospective observational study with 100 patients was done to predict difficult laparoscopic cholecystectomy and the possibility of conversion to open cholecystectomy before surgery. Results: The patients' average age was 38.91 years. Majority of the patients (62%) were in the normal range while 10 (10%) and 28 (28%) patients were overweight and obese respectively. 16% of the patients had previous history of hospitalization of acute cholecystitis while 84 (84%) patients had no history of hospitalization of acute cholecystitis. 30 (30%) patients presented With abdominal scar of which 4 (4%) patients had supraumblical scar while remaining 26 (26%) patients had an infraumblical scar. Conclusion: This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is a need for further prospective study for the validation of this score. There is scope for further refinement to make the same less cumbersome and easier to handle. This study was targeted at identifying the possible predictors of difficulty in LC. The data generated from the present study concludes that NAC improves the clinical features, biochemical markers of insulin resistance, hormonal levels, Anovulation and consequently the long-term health status of women with PCOS through inhibition of oxidative stress and improvement of peripheral insulin more effectively when compared with metformin. Due to the lack of adverse effects, NAC can be regarded as an appropriate substitute for insulin-reducing medications in the treatment of PCOS patients.