Predicting difficult laparoscopic cholecystectomy (original) (raw)
Related papers
2021
Introduction: Laparoscopic cholecystectomy (LC) has replaced open technique as the main surgical intervention in the treatment of gall bladder stones. There are different clinical and radiological predictors that are indicators for technically difficult LC. Aim of the work: The aim of this study was to identify the clinical and radiological variables associated with difficult LC. Methods: During the period from March 2018 to March 2021, 452 adult patients who presented with symptomatic gall bladder stones underwent LC. Different clinical and radiological data were collected as: abdominal scar, palpable gall bladder, previous hospitalization, history of ERCP, total leucocyte count, thickness of the gall bladder wall, peri-cholecystic collection, solitary or multiple gall bladder stones, impacted stone and diameter of the CBD. Results: Age of 50 years or over (P value 0.001), male gender (P value 0.001), previous hospital admission (P value 0.001), impacted stones (P value 0.003), and leukocytosis (P value 0.031) were found statistically significant with area under ROC curve is 0.814 with 95 % confidence interval. Conclusion: These preoperative risk factors; old age, male gender, previous hospitalization for biliary problem, impacted stone, and leukocytosis could potentially predict difficult LC, and give surgeons and their assistants the chance to predict the risk of complications intraoperatively and the possibility to convert the maneuver to a bail-out one.
Preoperative prediction of difficulty during laparoscopic cholecystectomy
Introduction: To determine the risk factors predicting difficulty during laparoscopic cholecystectomy (LC). Experimental: Surgical V, Civil Hospital and Surgical II, Fatima Hospital (Karachi) between January and November 2008. There were 100 cases of cholelithiasis admitted through outpatient department (OPD) for elective surgery. Clinical features, laboratory investigations and outcome of surgery were recorded on a data collection form. Conversion to open surgery and long operating time were the indicators of difficult laparoscopic dissection. A p-value of <0.05 was considered significant. Results and Discussion: Nine patients required conversion to open surgery, and seven of them were predicted for difficulty. Factors strongly predicting conversion, having p-value <0.05, were: vomiting, previous acute cholecystitis, previous jaundice, tenderness in right hypochondrium, leucocytosis, gallbladder wall thickness of 2mm or more, contracted gallbladder, pericholecystic fluid, and gallbladder adhesions. Conclusions: Operative difficulty of laparoscopic cholecystectomy can be predicted with careful preoperative assessment.
International Journal of Medical Science and Clinical invention
Introduction: Laparoscopic cholecystectomy has become the procedure of choice for the management of symptomatic gallstone disease. Difficulty in laparoscopic cholecystectomy is often encountered by surgeons and is associated with complications and a higher conversion rate. This study aims at identifying difficult laparoscopic cholecystectomies by clinical and imaging assessment and determining the utility of a pre-operative difficulty scoring system based on intra-operative findings. PATIENTS and METHODS: A hospital based observational study was conducted including all patients above age 18 years undergoing laparoscopic cholecystectomy. Randhawa’s preoperative score was calculated for every patient based on history, clinical and imaging parameters and the degree of operative difficulty was predicted. Another scoring was done using Sugrue’s scoring system based on intra-operative findings. The outcome factors studied were degree of operative difficulty or need for conversion and int...
SCORING SYSTEM FOR PREDICTING RISK FACTORS FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY.
Laparoscopic cholecystectomy proved to be the gold standard in the treatment of cholelithiasis and is replacing open cholecystectomy. The rate of conversion from laparoscopic cholecystectomy to open cholecystectomy range from 5-10 %, that\'s why it is necessary to study the predictive factors for difficult laparoscopic cholecystectomy. 115 patients were all subjected to ultrasonographic examination. The patients confirmed by US examination are evaluated with following factors: age, sex, BMI, h/o previous hospitalization, h/o previous abdominal surgeries, h/o acute cholecystitis. Ultrasonographic findings were Gall bladder wall thickness (> or < 4mm), pericholecystic fluid collection, number (solitary versus multiple) and liver texture (normal, fatty infiltration or fibrosis). Following evaluation the patients were subjected to laparoscopic cholecystectomy and the following operative parameters were assessed: access to peritoneal cavity (easy, difficult), bleeding during surgery (normal, abnormal), gall bladder bed dissection (easy, difficult), injury to duct/artery, and conversion to open surgery. In the present study, BMI > 30, history of cholecystitis, gall bladder wall thickness > 4mm, palpable gall bladder, pericholecystic fluid collection, impacted stone were significant predictive factors for difficult laparoscopic cholecystectomy .
Assessment of difficult Laparoscopic cholecystectomy based on clinical and radiological findings
2020
Background: Laparoscopic cholecystectomy is common procedure done in minimal invasive procedures. It is the treatment of choice for symptomatic gall stone disease all around the world. Methodology: This is case control study done in 198 patients undergoing laparoscopic cholecystectomy. Patients randomly divided as case and controls based on preoperative clinical criteria and radiological features. Results: 198 patients underwent laparoscopic cholecystectomy. Their mean age was 46.19 ± 13.03 years. There was female preponderance with 143 (72.2%) females as compared to 55 (27.8%) males. Difficult cholecystectomy was labelled in 55 (27.8%) cases based on intra-operative criteria mentioned in methodology. 13 (6.6%%) required conversion to open cholecystectomy. Easy cholecystectomies scored 0.81 as compared to 8.18 in the difficult group. The sensitivity of the preoperative score in predicting difficult cases was 98.2% with the specificity of 95.8%; positive predictive value of 90.0% and...
Factors predicting difficult laparoscopic cholecystectomy: A single-institution experience
International Journal of Students� Research, 2014
Background: Laparoscopic cholecystectomy is one of the most common operations performed by general surgeon. This study was performed to evaluate pre-operative factors predicting difficult laparoscopic cholecystectomy. Methods: A prospective study was carried out at Jawaharlal Nehru Medical College Hospital, Ajmer, a tertiary care centre in Middle East Rajasthan, India. In present study we included 100 patients diagnosed with symptomatic gallstones disease on the basis of history, clinical examinations and USG findings and underwent laparoscopic cholecystectomy in our hospital by a single surgeon during the period of July 2014 to July 2016. These all patients were evaluated for a group of risk factors and preoperatively these risk factors were given a score between 0-5 labeled as easy, 5-10 as difficult and 11-15 as very difficult. Statistical analysis was done by Fischer's test and chi square test. Results: BMI >30, previous medical disease like DM, palpable gall bladder, prior hospitalization pericholecystic collection and impacted stone are significant risk factors to predict difficult laparoscopic cholecystectomy. Conclusions: The studied scoring system had a positive prediction value for easy prediction of 94% and for difficult prediction of 100%.
Assessment of risk factors for difficult surgery in laparoscopic cholecystectomy
2017
Background: Laparoscopic cholecystectomy (LC) may be rendered difficult surgery. Prediction of a difficult LC would allow the surgeon to discuss the likelihood of conversion with the patient and prepare the patient psychologically as well as planning their recovery and explaining their ab aim to assess the preoperative factors for prediction of difficulty of LC and the possibility of conversion to open cholecystectomy before surgery using the clinical, pathological and ultrasonological criteria. This study was carried out on 60 patients with symptomatic cholelithiasis, normal liver function tests and non ducts scheduled for LC. Age, sex, body mass index, previous abdominal surgery and past history of acute attack of cholecystitis of the patients were recorded. Apre investigations. Results: Overall conversion rate was 3.3%. Univariate analysis showed that sex, fever at the time of attack, gall bladder wall thickness, p leucocyte count were significant for conversion. can be informed ...