A clinical study to determine predictive factors for difficult laparoscopic cholecystectomy

Mudgal, Madan Mohan; Kushwah, Naveen; Singh, Raghvendra; Gehlot, Himanshu

doi:10.5455/ijmsph.2018.1232719122017

Cited by 3 publications

(6 citation statements)

References 8 publications

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“…In the current study found female preponderance (88.1%), a finding which is in consistence with several study reports [2,6,12,15,21,22,23,27,28]. High incidence of gallstones in females has been suggested due to the effect of estrogen and progesterone on biliary cholesterol level and gallbladder motility [2,6].…”

Section: Discussionsupporting

confidence: 91%

“…In this study, difficult laparoscopic cholecystectomy confronted the surgical team in 137 patients (33.8%), which is similar to what were reported by Atta H et al (32%) [7], Mudgal M (34%) [15], as well as Singh K et al (34%) [22], and located between the two extreme ratios which were mentioned by Nidoni R et al (24.4%) [17],and Verma D et al (46%) [29]. The study showed conversion rate of 6.4%, which compares well with the incidence reported in the literature, which varies from 2-15% [6,17,21,22,23].…”

Section: Discussionsupporting

confidence: 89%

“…Consistently, Abdulhamid M et al found significant association with it and open conversion [2]. Mudgal M et al regarded previous abdominal surgery as significant predictive factor for difficult laparoscopic cholecystectomy [15]. Leukocyte count showed statistically significant association with difficult laparoscopic cholecystectomy on univariate analysis (Man-Whitney test) with significance of p = 0.001.…”

Section: Discussionmentioning

confidence: 78%

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Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Bin-Gadeem

2021

Univ. Aden J. Nat. and Appl. Sc.

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Laparoscopic cholecystectomy become the treatment of choice for symptomatic gallstone disease. Difficult procedure may confront the surgeon, but these situations are often predictable based on a number of clinical and paraclinical factors. This study aimed to determine which clinical and paraclinical factors are associated with difficult laparoscopic cholecystectomy. Total of 405 patients with symptomatic gallstone disease, who underwent laparoscopic cholecystectomy between 1st Marc 2018 and 29th February 2020,in 22 May Hospital, Aden, were included in the study. Patient with gallbladder cancer or acalcular cholecystitis were excluded from the study. Relevant data which include clinical and paraclinical findings as well as operative findings were collected to a specially designed questionnaire form. Data analysis was done by SPSS version 17 software. Univariate analysis for categorical variables was done using Chi square or Fischer's exact test. Continuous data were tested for normal distribution and analyzed using Mann Whitney test. P- value <0.05 was considered statistically significant. Female preponderance (88.1%) was observed. Mean age was 42.6 ± 13.7. Difficult laparoscopic cholecystectomy found in 137 patients (33.8%). A statistically significant association were found between difficult laparoscopic cholecystectomy and gender (p-value <0.001), history of obstructive jaundice (p-value<0.001), previous endoscopic retrograde cholangio-pancreaticography (p-value <0.001), previous abdominal surgery (p-value =0.005), white blood cell count (p-value= 0.001), gallbladder wall thickness ≥ 4mm (p-value <0.001) , impacted stone in cystic duct (p-value <0.001), pericholecystic fluid collection (p-value <0.001), dilated common bile duct more than 7 mm (p-value =0.001), contracted gallbladder despite adequate fasting (p-value <0.001). Number of preoperative factors were identified, which have statistically significant association with difficult laparoscopic cholecystectomy. Knowledge of these factors by the surgeon before operation is imperative to make the necessary precautions before operation.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 78%

See 1 more Smart Citation

Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Bin-Gadeem

2021

Univ. Aden J. Nat. and Appl. Sc.

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“…In many recently published studies, difficult laparoscopic cholecystectomy was observed in about one third of the operated patients which make preoperative assessment for difficult operation and planning for safe surgery is prudent [5,6,19,24] . Undoubtedly, clinical and paraclinical assessment including imaging studies of patients with gallbladder stone disease, can reveal individual factors associated with difficult laparoscopic cholecystectomy and are indispensable parts in the management and decision making process [31].…”

Section: Introductionmentioning

confidence: 99%

“…It can be regarded as an instrument in the hand of the surgeon, which could help him a lot. During the last decade, several scoring systems have been developed [3,16,19,23], but they are far from optimal [11]. They differ; some were used to predict difficult procedure, whereas others were used to predict risk of conversion or adverse outcome.…”

Section: Introductionmentioning

confidence: 99%

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Bin-Gadeem

2022

Univ. Aden J. Nat. and Appl. Sc.

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Preoperative scoring system to predict difficult laparoscopic cholecystectomy can be regarded as an instrument in the hand of the surgeon, which could help him to prepare for difficult operation, make better preoperative counseling of the patient, and in general, it is a further step towards the safe, modern, surgical practice. The study aimed developing a simple scoring system to predict difficult laparoscopic cholecystectomy preoperatively, which can be used in the daily clinical practice. This is a retrospective study carried out in the 22 May Hospital, Aden, from 1st March 2018 to 29th February 2020. It included 405 patients who had laparoscopic cholecystectomy, and among them, 137 had difficult operation. 10 variables were subjected for multivariate study (binary logistic regression) which had shown association with difficult laparoscopic cholecystectomy on previous univariate analysis. Statistical software SPSS version 17 was used for this purpose and significance level was set to p< 0.05. The necessary predictors (independent factors) which were able to explain the outcome (difficult laparoscopic cholecystectomy) were identified with statistical significance. The effect size of these predictors was rounded and the new values were adopted as scores for each factor. A scoring system was constructed from these factors and their scores. The accuracy of the new score system was tested by the ROC analysis against the same sample.7 predictors were identified. Depending on these variables, the prediction for easy laparoscopic cholecystectomy came true in 87% of cases and the prediction for difficult laparoscopic cholecystectomy came true in 85% of the cases. The returned area under the curve was 0.913, with 95% confidence interval. A score above 2.25 was considered difficult with sensitivity and specificity of 82.25% and 85.8% respectively. There were no cases with score above 9. From the findings of the current study, it could be concluded that the new scoring system had good predictive capability to difficult laparoscopic cholecystectomy and it incorporates simple, few determinants, which could help surgeon and improve patient curative care.

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Evaluation of Clinico-Radiological Factors Predicting Difficult Laparoscopic Cholecystectomy

Ali

Nanen

Rab

et al. 2021

IJAR

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Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.

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A clinical study to determine predictive factors for difficult laparoscopic cholecystectomy

Cited by 3 publications

References 8 publications

Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

Simple preoperative scoring system to predict difficult laparoscopic cholecystectomy

Evaluation of Clinico-Radiological Factors Predicting Difficult Laparoscopic Cholecystectomy

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