A Study of Pre-Operative Predictors of Difficult Laparoscopic Cholecystectomy

This study was aimed to assess various pre-operative predictors (history/ clinical/ imaging) and develop a scoring method for difficult laparoscopic Cholecystectomy and to correlate preoperative predictive factors with intraoperative difficulty in lap Cholecystectomy. Laparoscopic Cholecystectomy (LC) has become the procedure of choice for management of symptomatic gall stone disease. The following conclusions can be drawn from the study; Surgeons encounter difficulty when there were dense adhesions in the Calot’s triangle, fibrotic and contracted GB , acutely inflamed, gangrenous gall bladder and cholecystoenteric fistula etc. There are many risk factors which make laparoscopic surgery difficult like old age, male sex, attacks of acute Cholecystitis and pancreatitis , obesity, previous abdominal surgery, palpable gall bladder and certain ultrasonographic findings i.e. thickened gall bladder wall, distended gall bladder, pericholecystic fluid collection, impacted stone etc. Six parameters namely male sex, up, previous episode of Cholecystitis , previous upper abdominal surgery, sonographically ascertained thick gallbladder wall, age greater than60 years and preoperative diagnosis of acute Cholecystitis were found to have significant effect on risk of conversion on statistical analysis. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery, future studies should focus on studying the difference when different surgeons operate and how far the grading system is reliable between them baseline being a standard experience in laparoscopic surgery