Prediction of difficulties during laparoscopic cholecystectomy by preoperative clinical examination and ultrasonography

Arun Kumar, Kunwar Vishal Singh, Jugendra Pal Singh Shakya, Sangita Sahu, Soniya Dhiman, Neelabh Agrawal


Background: Cholelithiasis (gall stone disease) is a well-known disease worldwide. Ultrasonography is the most common screening test for cholecystitis and cholelithiasis. Laparoscopic Cholecystectomy is considered the treatment of choice for symptomatic gall stone disease. It is important to know the different clinical, radiological parameter and specific predictor that give some prediction of difficult LC. The aim of this study was to predict the difficulty of LC and the possibility of conversion to OC before surgery using the clinical and ultrasonographic criteria in our set up.

Methods: The present study was carried out in the Department of surgery, Sarojini Naidu Medical College Agra, from November 2014 to October 2016.  A total of 210 patients were enrolled for the laparoscopic cholecystectomy. All patients who were included in the study were undergone detailed history and clinical examination. A number of clinical and ultrasonographical parameters were noted.

Results: Amongst the 210 patients admitted for laparoscopic cholecystectomy, 21 (10%) were male and 189 (90%) female, with age ranging from 12–60 years.  The conversion rate in our study was 4.5% (9 of 210). In our study significant pre-operative factors which increased the conversion rate to open cholecystectomy includes male gender, obesity, abdominal scar of previous surgery, contracted and thickened gall bladder and patients having stone impacted at the neck of gall bladder.

Conclusions: From this study, we conclude that preoperative ultrasonography is a good predictor of difficult laparoscopic cholecystectomy in the majority of cases and should be used as a screening procedure.


Laparoscopy cholecystectomy, Open cholecystectomy

Full Text:



Maya MCA, Freitas RG, Pitombo MB, Ronay A. Colecistite Aguda: diagnóstico e tratamento. Revista do Hospital Universitário Pedro Ernesto. UERJ. 2009;8(1):1676-80.

Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20(6):981-96.

Sahu SK, Agrawal A, Sachan PK. Intraoperative difficulties in laparoscopic cholecystectomy. Jurnalul de Chirurgie (Iaşi). 2013;2:149-55.

Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991;161(3):385-7.

The Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med. 1991;324(16):1073-8.

Liu CL, Fan ST, Lai EC, Lo CM, Chu KM. Factors affecting conversion of laparoscopic cholecystectomy to open surgery. Arch Surg. 1996;131(1):98-101.

Abdel Baki NA, Motawei MA, Soliman KE, Farouk AM. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. J Med Res Inst. 2006;27(3):102-7.

Capizzi FD, Brulati FM, Boschi S. Conversion rate in laparoscopic cholecystectomy evaluation from 1993 and current state. J Laparosco Adv Surg Tec. 2003;13(2):7-13.

Palanivelu C. Difficult Laparoscopic Cholecystectomy. In: Parthasarathi R, editor. Art of Laparoscopic Surgery. Textbook and Atlas. 1st ed. India: Jaya Publications; 2005:607-634.

Habib FA, Kolachalam RB, Khilnani R, Preventza O, Mittal VK. Role of laparoscopic cholecystecomy in the management of gangrenous cholecystitis. Am J Surg. 2001;181(1):71-5.

Angrisani L, Lorenzo M, De Palma G, Sivero L, Catanzano C, Tesauro B, et al. Laparoscopic cholecystectomy in obese patients compared with non-obese patients. Surg Laparosc Endosc. 1995;5(3):197-9.

Simopoulos C, Botaitis S, Polychronidis A, Tripsianis G, Karayiannakis AJ. Risk factors for conversion of laparoscopic cholecystectomy to open cholecystectomy. Surg Endosc. 2005;19:905-9.

Fried GM, Barkun JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167(1):35-41.

Sanabria JR, Gallinger S, Croxford R, Strasberg SM. Risk factors in elective laparoscopic cholecystectomy for conversion to open cholecystectomy. J Am Coll Surg. 1994;179(6):696-704.

Jansen S, Jorgensen J, Caplehorn J, Hunt D. Preoperative ultrasound to predict conversions in laparoscopic cholecystectomy. Surg Laparosc Endosc. 1997;7(2):121-3.

Brodsky A, Matter I, Sabo E, CohenA, Abrahamson J, Eldar S. Laparoscopic cholecystectomy for acute cholecystitis: can the need for conversion and the probability of complications be predicted? A prospective study. Surg Endosc. 2000;14(8):755-60.

Bedirli A, Sakrak O, Sözüer EM, Kerek M, Güler I. Factors effecting the complications in the natural history of acute cholecystitis. Hepatogastroenterology. 2001;48(41):1275-8.

Brunt LM, Quasebarth MA, Dunnegan DL, Soper NJ. Outcome and analysis of laparoscopic cholecystectomy in the extremely elderly. Surg Endosc. 2001;15(7):700-5.

O’Leary DP, Myers E, Waldron D, Coffey JC. Beware the contracted gallbladder - Ultrasonic predictors of conversion. Surgeon. 2013;11:187-90.

Lein HH, Huang CS. Male gender: risk factor for severe symptomatic cholelithiasis. World J Surg. 2002;26(5):598-601.

Kama NA, Doganay M, Dolapci M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open surgery. Surg Endosc 2001;15:965-8.

Lipman JM, Claridge JA, Haridas M. Preoperative findings predict conversion from laparoscopic to open cholecystectomy. Surg. 2007;142:556-65.

Ishizaki Y, Miwa K, Yoshimoto J. Conversion of elective laparoscopic to open cholecystectomy between 1993 and 2004. Br J Surg. 2006;93:987-91.

Tang B, Cuschieri A. Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg. 2006;10:1081-91.

Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg. 2002;184:254-8.

Underwood RA, Soper NJ. Laparoscopic cholecystectomy and choledocholithotomy. In: Blumgart LH, Fong Y editors. Surgery of liver and biliary tract. 3rd ed. London: W.B. Saunders Company Ltd; 2002:709-712.

Khanna S. How to predict difficult laparoscopic cholecystectomy and when to convert. IAGIS. 2012;1(1):28-30.

Hutchinson CH, Traverso LW, Lee FT. Laparoscopic cholecystectomy. Do preoperative factors predict the need to convert to open? Surg Endosc. 1994;8(8):875-8.

Shrestha S, Shah S, Poudyal S, Shah JN, Jaiswal VK. Conversion from laparoscopic to open cholecystectomy. JPAHS. 2014;1(1):30-2.

Nachnani J, Supe A. Preoperative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol. 2005;24(1):16-8.

Singh K, Ohri A. Laparoscopic cholecystectomy - is there a need to convert? J Minim Access Surg. 2005;1(2):59-62.

Chau CH, Siu WT, Tang CN, Ha PY, Kwok SY, Yau KK, et al. Laparoscopic cholecystectomy for acute cholecystitis: the evolving trend in an institution. Asian J Surg. 2006;29(3):120-4.