Assessment of a Scoring System to Predict Difficult Laparoscopic Cholecystectomy (original) (raw)
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Predicting difficult laparoscopic cholecystectomy
International Surgery Journal
Background: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for gallstone disease. Though mostly safe occasionally it can be difficult due to various problems faced during surgical procedure. Anticipation of likely difficulty can help in avoiding complications.Methods: With the aim of identifying various predictors of difficulty and their correlation with likely difficulty this prospective study on 50 adults undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis was undertaken. Various clinical, radiological and biochemical predictors and frequency and type of intraoperative difficulty was recorded.Results: In present study adverse clinical factors only showed significant predictive value (p value - 0.005). Adverse radiological predictors although showing trend towards, did not achieve statistical significance (p value 0.065). In clinical predictors duration of symptoms >1yr, History of acute cholecystitis and BMI >30 showed statistical...
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.
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%.
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...
International Surgery Journal, 2016
Laparoscopic cholecystectomy (LC) after its introduction by Mouret has replaced open Cholecystectomy as standard treatment. 1 Now laparoscopic cholecystectomy is one of most commonly performed procedure by General surgeon, and also of very much of interest for trainee to learn basic of laparoscopic procedure. 2 As we all know advantages of laparoscopic procedure for Gall Bladder in comparison to open procedure, safe dissection is most important component of successful LC. The difficult laparoscopic cholecystectomy (DLC) is a nightmare for surgeons but the definition of DLC is not well established and may vary from surgeon to surgeon. 3-5
Preoperative prediction of difficult laparoscopic cholecystectomy: A scoring method
Nigerian Journal of Surgery, 2015
Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. Approximately, 2-15% of attempted LC has to be converted to an open procedure due to various difficulties faced while performing the procedure. [1] Various clinical and ultrasonological parameters that may help to predict the difficulty level preoperatively were analyzed in the present study. Such prediction done preoperatively may help the patient as well as the surgeon in being better prepared for the intra-operative challenges. MAterIAls And Methods The proposed study was conducted in the Department of General Surgery, Government Medical College, Amritsar. Thirty consecutive cases were taken and the scores were given based on history, clinical examination and sonological findings, 1-day prior to surgery. The scoring system used was of Randhawa and Pujahari [2] [Table 1]. The scores were added up to get a total score and the patients were divided into categories of risks based on the total score [Table 2].
Pre Operative Prediction of Difficult Laparoscopic Cholecystecto my Using Scoring System.
IOSR Journals , 2019
Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard now for symptomatic Gall stones. Any unexpected turn of events intra-operatively has significant implications which get multiplied many fold due to high number of procedures. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon ,it leads to increased stress during operation and time pressure to complete the operative list .If degree of technical difficulty could be predicted before starting the procedure, concerned team can be better prepared and adverse outcomes can be potentially minimized. Aim: 1.To assess the preoperative predictors of difficulty in laparoscopic cholecystectomy. 2.To assess the preoperative risk factors based on the scoring system Materials and Methods: In this Prospective study,sixty patients with indication for laparoscopic cholecystectomy admitted in general surgery department, ESIC MC &PGIMSR, Bengaluru with a Study period: December 2017 to June 2019. All the patients were assessed pre-operatively according to history,clinical examination and sonological findings. Chi-square test and student t test were used for statistical analysis. Results: Difficulty of doing surgery increased with age, history of previous admissions for acute cholecystitis,palpable gall bladder and obesity. No difference was found in difficulty score for impacted stone in neck of gall bladder,pericholecystic collection. Recurrent cholecystitis, prior-hospitalisation, length of hospital-stay and duration since first episode predicted a difficult LC but not duration since last episode. Presence of tenderness and Murphy's sign had no relation with the difficulty score. Conclusion: Our results demonstrate that difficult LC can be predicted based on parameters on history and physical examination alone at the first visit of the patient to OPD. Both the patient and surgical team can, therefore, be better prepared for the possible complications and conversions in an environment of confidence and mutual trust. The scoring system evaluated has got sensitivity=96.0%, specificity=68.6%, ppv=68.6%, npv=96.0%.