Predicting difficulty in laparoscopic cholecystectomy by clinical, hematological and radiological evaluation

Chandrashekhar Naik G., Kailas C. T.


Background: Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic cholelithiasis. It has revolutionized minimally invasive procedures. Laparoscopic cholecystectomy may be rendered difficult by various problems encountered during surgery. The aim of this study was to predict difficulty of LC and possibility of conversion to open cholecystectomy (OC) before surgery using the clinical, haematological and ultrasonographic criteria.

Methods: This study was carried out on 50 patients with symptomatic cholelithiasis, non-dilated bile ducts. All patients underwent abdominal ultrasound examination. All cases underwent laparoscopic cholecystectomy with assessment of the difficulties encountered.

Results: LC was successfully accomplished in 49 patients (98%) with a mean operative time of65.122 ± 26.87 minutes. Adhesions present in 14 cases (28%). Gall bladder bed dissection was difficult in 4 patients (8%). Aberrant anatomy present in 4 cases (8 %) while stone spillage occurred in 3 patients (6%) and were all retrieved. Extraction of the excised gall bladder was difficult in 4 patients (8%). Conversion to laparotomy occurred in 1 patients (2%). The preoperative parameters that significantly predicted difficult LC were based on the presence of BMI >27.5, history of prior hospitalization, palpable gallbladder, ultrasonographic features of impacted stone and gall bladder wall thickening.

Conclusions: Preoperative evaluatuion may help predict a difficult LC. This information may be useful to both the patient and the treating surgeon. 


Cholecystectomy, Evaluation, Laparoscopy

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