Preoperative Prediction of Difficult Laparoscopic Cholecystectomy

Dr. Harish Chauhan, Dr Vikramaditya Oza, Dr Lalit Patel, Dr Samarth Patel

Abstract: This study has been carried out at our institute during period of February 2016 to November 2016, in all 122 cases were studied. Patients who attended the surgical outpatient department and emergency department were included in the study. All patients presenting in casualty or outpatient department with history suggestive of gall bladder disease were investigated. Abdominal ultrasonography was performed at the time of admission and reviewed 24 hours before the surgery after a 12-hour fast. Patients with ultrasonography suggestive of single or multiple gall stones or acalculous cholecystitis were included in the study. Cases were investigated as mentioned in proforma and selected for laparoscopic cholecystectomy as per inclusion and exclusion criteria. Operation time is taken as indicator of difficulty. A policy of converting to open cholecystectomy if no progress in dissection of Calots triangle within 30 minutes, was adopted throughout the study10. Preoperative clinical parameters like previous acute cholecystitis or pancreatitis, obesity (BMI 30 kg/m2), sex were evaluated. Their association with conversion of laparoscopic cholecystectomy was studied. Preoperative ultrasonographic parameter like gall bladder wall thickness >3 mm and its association with conversion of laparoscopic cholecystectomy to open cholecystectomy was studied.

Keywords: Laparoscopic cholecystectomy, Open cholecystectomy, Difficult cholecystectomy, Predictive factors