Preoperative predictors of level of difficulty of laparoscopic cholecystectomy

Abstract

Background:Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder stone disease. This is due to its safety, reliability, cost-effectiveness, negligible mortality, shorter duration of hospitalization (early return to work), better cosmesis, minimal wound complications, and temporary paralytic ileus. In spite of these, conversion to open cholecystectomy which is sometimes required in difficult cases could be challenging.Aims and Objectives:The aim of the present study is to aid the prediction of difficult cases undergoing LC, thereby better selection of patients with the least conversion rates.Materials and Methods:This prospective study was conducted on 100 consecutive patients with cholecystitis, over a 2-year period from January 1, 2017, to December 31, 2018, having undergone LC. Various preoperative parameters, including age, sex, previous attacks of cholecystitis, deranged liver functions, and ultrasonographic findings, were analyzed for their effects for predicting the level of difficulty during LC.Results:Twenty-five percent of the cases were correctly predicted as difficult in the age group of >65 years. Cholecystitis was more common (79%) in females, but difficulties were encountered more frequently while performing LC in males. Abnormal serum hepatic and pancreatic enzyme profiles were associated with difficulties during surgery as about 83.3% of the patients predicted as moderately difficult peroperatively had deranged liver functions. The preoperative ultrasonography findings were helpful for predicting the degree of difficulty involved in the procedure. About 33.3% of the patients that had pericholecystic fluid on ultrasound preoperatively were correctly predicted to have moderately difficult surgeries. The Chi-square test and P value were used to determine statistical significance.Conclusions:Females, the absence of previous repeated attacks of cholecystitis and hospitalizations, no upper abdominal surgery in the past, normal liver function tests, normal amylase levels, nondistended and uncontracted gallbladder, absence of pericholecystic collection, afebrile, and single stone are positive preoperative predictors of safe LC in symptomatic gallbladder stone disease.

Safe Laparoscopic Cholecystectomy: Adoption of Universal Culture of Safety in Cholecystectomy

“…Presently, laparoscopic cholecystectomy is used widely as a standard procedure for benign gall bladder diseases which need cholecystectomy. LC decrease postoperative pains, allow early oral intakes, shorten hospitalization, faster back to ordinary activities, and progresses cosmoses over open operation (6) .…”

Peri‐operative Mortality Following Cholecystectomy in Australia: Potential Preventability of Adverse Events

“…It is interesting to note that while women are twice as likely to have biliary disease [8, 9], men represent a larger proportion of post‐operative deaths. Indeed, several studies report higher difficulty levels when performing cholecystectomy on men and identify male gender as a mortality risk factor [1, 10, 11]. However, the literature is divided on whether gender has prognostic significance.…”

Single-Incision Laparoscopic Cholecystectomy Using the Marionette Transumbilical Approach Is Safe and Efficient with Careful Patient Selection: A Comparative Analysis with Conventional Multiport Laparoscopic Cholecystectomy

“…The National Institutes of Health consensus statement first recognized laparoscopic cholecystectomy as “the treatment of choice for many patients” in 1992. 1 Advancement in laparoscopic technology and improved laparoscopic expertise has since resulted in the three- or four-port conventional laparoscopic cholecystectomy (CLC) becoming the standard of care for symptomatic cholelithiasis. Today, ∼460,000 laparoscopic cholecystectomies are performed in the United States annually.…”

“…Laparoscopic approach is preferred over open cholecystectomy for several reasons, including superior outcomes in terms of safety, cosmesis, recovery time and hospital length of stay (LOS), and cost-effectiveness. 2 3 …”

“…Laparoscopic approach is preferred over open cholecystectomy for several reasons, including superior outcomes in terms of safety, cosmesis, recovery time and hospital length of stay (LOS), and cost-effectiveness. 2,3 Newer innovative techniques that attempt to further push boundaries and improve outcomes include the natural orifice transluminal endoscopic surgery, single-incision laparoscopic cholecystectomy (SILC), and robot-assisted SILC. 4 SILC is costeffective, reduces postoperative pain, and improves cosmetic results and patient satisfaction.…”