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Research Paper | General Surgery | India | Volume 12 Issue 5, May 2023
Preoperative Predictive Factors in Case of Difficult Laparoscopic Cholecystectomy at Tertiary Center
Abstract: Introduction: Laparoscopic cholecystectomy has become standard treatment for cholecystitis and cholelithiasis. Despite advances there are few things that make surgery difficult. Preoperative assessment for level of difficulty helps in deciding the approach of surgery, reduces the morbidity, reduces complications rate and also gives a better outcome. Aim: To detect preoperative predictors of intraoperative difficulties in Laparoscopic cholecystectomy, to evaluate predictor for conversion to open cholecystectomy and to validate a scoring system to predict difficult laparoscopic. Material method: Study was conducted in Moti Lal Nehru Medical college, prayagraj. All eligible patients undergoing Laparoscopic cholecystectomy in unit at department of general surgery at our institute were included. Study was done during October 2021 to September 2022. Preoperative difficulty parameters and intraoperative difficulty were assessed by scoring given by Randhawa J S et al. Each individual parameter (Age, Gender, History of Hospitalization for acute cholecystitis, BMI, Abdominal scar, Palpable gallbladder, Thick Gallbladder wall, pericholecystic collection and impacted stone at neck) was evaluated for association with intraoperative outcome. Result: On evaluating score, 55 patients scored 0 - 5 easy score and among them 2 (3.6%) had very difficult outcome, 6 (10.9%) had difficult outcome and 47 (85.5%) had easy outcome. Proportion of difficult laparoscopic cholecystectomy was higher in Males, patients who had previous history of hospitalization for acute cholecystitis and patients who had pericholecystic collection. Conclusion: Score by Randhawa JS et al, resulted sensitivity of 65.22% and specificity of 87% in predicting difficult laparoscopic cholecystectomy. Which makes score reasonably good. Proportion of difficulty is higher in male, patients with history of hospitalization and pericholecystic collection.
Keywords: Predictive factors for Difficult Laparoscopic Cholecystectomy, factors associated with Difficult cholecystectomy, Male gender associated with difficult laparoscopic cholecystectomy
Edition: Volume 12 Issue 5, May 2023,
Pages: 1474 - 1479