A Standardized Ultrasound Scoring System for Preoperative Prediction of Difficult Laparoscopic Cholecystectomy

Abstract

PurposeLaparoscopic cholecystectomy (LC) has become the treatment of choice for cholelithiasis. Still some patients required conversion to open cholecystectomy (OC). Our aim was to develop a standardized Ultrasound based scoring system for preoperative prediction of difficult LC.Methods and materialsUltrasound findings of 300 patients who underwent LC were reviewed retrospectively. Four parameters (time taken, biliary leakage, duct or arterial injury, and conversion) were analyzed to classify LC as easy or difficult. The following ultrasound findings were analyzed: GB wall thickness, pericholecystic collection, distended GB, impacted stones, multiple stones, CBD diameter and liver size. Out of seven parameters, four were statistically significant in our study. A score of 2 was assigned for the presence of each significant finding and a score of 1 was assigned for the remaining parameters to a total score of 11. A cut-off value of 5 was taken to predict easy and difficult LC.Results66 out of 83 cases of difficult LC and 199 out of 217 cases of easy LC were correctly predicted on the basis of scoring system. A score of >5 had sensitivity 80.7% and specificity 91.7% for correctly identifying difficult LC. Prediction came true in 78.8% difficult and 92.6% easy cases. US findings of GB wall thickness, distended GB, impacted stones and dilated CBD were found statistically significant.ConclusionThis indigenous scoring system is effective in predicting conversion risk of LC to OC. Patients having high risk may be informed and scheduled appropriately and decision to convert to OC in case of anticipated difficulty may be taken earlier.

Accuracy of Randhawa and Pujahari Preoperative Scoring System in Prediction of Difficult Laparoscopic Cholecystectomy in Egyptian Population

“…In 2017, Siddiqui et al study found that there was no any statistical significance between difficulty during LC and the presence of pericholecystic collection, multiple stones or enlarged liver (20) .…”

“…In 2017, Siddiqui et al study found that patients with an impacted stone had higher incidence of operative difficulty and the association between the two was statistically significant (20) .…”

“…In gallstone disease, the most common reason for wall thickening is acute or chronic pericholecystic inflammatory change. An acutely inflamed and edematous GB wall may rupture with spillage of infected bile and stones can further limit visualization of the operative field, resulting in a more difficult operation (20) .…”

¿Es el ultrasonido útil o no para predecir si una colecistectomía debe hacerse abierta o laparoscópica?

“…El US está limitado en lo que se refiere a la identificación de variantes del árbol biliar. Otras modalidades de imagen, tales como la colangiopancreatogra-fía por resonancia magnética (CPRM) y la Colangiopancreatografía Retrograda Endoscópica (CPRE) pueden ser útiles en el abordaje preoperatorio y mejorar los resultados [32][33][34][35] .…”

Acute cholecystitis: predictive clinico-radiological assessment for conversion of laparoscopic cholecystectomy

“…Demographic, laboratory, and intraoperative factors that predict or contribute to conversion have been previously evaluated, but no consensus has emerged (3–7). In addition, some studies have conducted and published studies on radiologic factors contributing to conversion, but most studies have used ultrasound (US) findings (8–10). Despite the fact that contrast-enhanced computed tomography (CECT) is commonly performed in the emergency room for patients with acute abdominal pain and tenderness during the initial work-up, only a few studies on whether CT findings were associated with conversion to open cholecystectomy have been reported (11).…”