Pre-operative prediction of difficult laparoscopic cholecystectomy
DOI:
https://doi.org/10.18203/2349-2902.isj20151083Keywords:
Laparoscopic cholecystectomy, Gall bladder, Cholelithiasis, Difficult cholecystectomyAbstract
Background:Laparoscopic cholecystectomy has become the gold standard in the treatment of cholelithiasis and is replacing open cholecystectomy. The rate of conversion from laparoscopic cholecystectomy to open cholecystectomy is 5 to 10%. Hence it is necessary to study the predictive factors for difficult laparoscopic cholecystectomy.
Methods: All patients are subjected to ultrasonographic evaluation. The patients confirmed by USG examination are evaluated with following factors: age, sex, BMI, h/o previous hospitalization, h/o previous abdominal surgeries, h/o acute cholecystitis / pancreatitis. Sonographic findings: GB wall thickness (>/< 3 mm), pericholecystic collection, number (solitary versus multiple) and liver parenchyma (Normal, fatty infiltration, liver fibrosis). Following evaluation the patients will be subjected to laparoscopic cholecystectomy and the following operative parameters : access to peritoneal cavity (easy/difficult), bleeding during surgery (normal/abnormal), gall bladder bed dissection (easy/difficult), injury to duct/artery, extraction of gall bladder (easy/difficult), or conversion to open surgery are noted.
Results:In the present study, BMI >32.5, history of cholecystitis, previous abdominal surgery, GB wall thickness>3mm, pericholecystic collection, multiple stones and liver fibrosis were significant predictors of difficult laparoscopic cholecystectomy.
Conclusions:In about 5 to 10% of the cases of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gallbladder. Therefore it is necessary to analyse the risk factors that predict difficult laparoscopic cholecystectomy.
References
Das S. Biliary System. Chapter 38 In: A Concise Textbook Of Surgery, Das S 6th Edition. Sumanth Das, 2010.
Barkun JS, Barkun AN, Sampalis JS. Randomized Controlled Trial Of Laparoscopic Versus Mini-Cholecystectomy. Lancet. 1992;340:1116-9.
Bass EB, Pitt HA, Lillenore KD. Cost Effectiveness of Laparoscopic Cholecystectomy versus Open Cholecystectomy. Am J Surg. 1993;165:466-71.
Soper N, Barteau J, Clayman R. Laparoscopic Versus Standard Open Cholecystectomy: Comparisonof Early Results. Surg Gynaecol Obstet. 1992;174:114-8.
Boni L.. Infective complication of laparoscopic surgery. Surg infect (Larchmt). 2006;7suppl2:S109-11.
Kama NA, Dogary M, Dolapa M, Attli M. Risk factors resulting in conversion of laparoscopic cholecystectomy to open cholecystectomy. Surgical endoscopy. 2001:15(9):965-8.
Lein H, Huang C. Male gender: Risk factor for severe symptomatic cholelithiasis. World J Surg. 2002;26:598-601.
Fried GM, Barkun JS, Sigman HH, Joseph L, Uas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg. 1994;167(1):35-9.
Alponat A, Cheng K, Bee C Koh, Andrea R, Peter MY Goh. Predictive factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997;21:629-33.
Kanaan SA, Murayama KM, Merriam LT, Dawes LG, Puystowsky JB, Reye RB, Jochi RJ. Risk factors for conversion of laparoscopic to open cholecystectomy. J Surg Res. 2002;106:20-4.
