Study of 292 patients for prediction of difficult laparoscopic cholecystectomy using detailed history, clinical and radiological parameters

Arora, Devansh; Avasthi, Ankur; Kothari, Ankur; Dangayach, Krishan Kumar

doi:10.18203/2349-2902.isj20160258

Cited by 4 publications

(5 citation statements)

References 10 publications

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“…In our study, patients who had palpable gallbladder (7.5%) on clinical examination had more difficulties in operation when compared to non-palpable gallbladder. Similar finding were observed in study done by Agarwal et al, [15] 12% palpable. In our study, 49% had difficulty in operation with >40mins of duration of operation in older patients.…”

Section: Discussionsupporting

confidence: 91%

“…In our study, parameters in ultrasound of gallbladder such as wall thickness greater than 3mm and single stone in gallbladder are good predictors of difficulties in Laparoscopic cholecystectomy. Similar findings were observed in studies conducted by Nayak [13] , Lonare [15] and Yadav [16] had difficulties in operation with thickened gallbladder wall in ultrasound. In our study, diameter of CBD is not good predictor of difficulty, but studies done by Lonare et al, [15] had difficulty(>6mm) in operation with CBD dilated.…”

Section: Discussionsupporting

confidence: 90%

“…Similar findings were observed in studies conducted by Nayak [13] , Lonare [15] and Yadav [16] had difficulties in operation with thickened gallbladder wall in ultrasound. In our study, diameter of CBD is not good predictor of difficulty, but studies done by Lonare et al, [15] had difficulty(>6mm) in operation with CBD dilated. In our study Sensitivity (100%), specificity (98.83%), positive predictive value (93.94%), negative predictive value (100%) and Diagnostic accuracy (99%) of USG in detection of stone were observed.…”

Section: Discussionsupporting

confidence: 90%

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The Clinical Features, Ultrasonographical and Histopathological Findings in Cholelithiasis

H¹

2018

jmscr

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This prospective and descriptive study was conducted at the department of General Surgery, A total 100 patients mean age of presentation was 35.23±12.32 years, mean duration of operation was 40.32± 14.96 minutes. Age group of 21-40 (67%) was highly effected. Females (66%) were maximum affected than males(34%). The most common mode of presentation being pain (43%), followed by Nausea(21%), Dyspepsia (17%), Pain + Jaundice(10%) and Pain + Nausea(9%) in decreasing order, patients with palpable gallbladder(16%) had more difficulty in operation. USG thickness >3mm (42%) and single stone(19%) in ultrasound of gallbladder had difficulties in operation with duration of operation >40min. Sensitivity, Specificity, Positive predictive value, Negative predictive value and Diagnostic accuracy of detection of stone in ultrasound were 100%, 98.83%, 93.94%, 100% and 99% respectively. All specimens after operation sent for histopathological examination and found Chronic cholecystitis (74%) is maximum followed by Acutecholecystitis(23%) and Mucocele of gallbladder(3%). Out of 100 laparoscopic cholecystectomy, 5cases were converted to open-cholecystectomy due toadhesions around gallbladder which would not be detected in ultrasound.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 90%

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The Clinical Features, Ultrasonographical and Histopathological Findings in Cholelithiasis

H¹

2018

jmscr

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“…It leads to ongoing inflammation and fibrosis of gall bladder wall, thus making surgery very challenging. Similar findings are seen in study by Agarwal et al 8 In our series recurrent calculus cholecystitis was recognized as the most common pathology giving rise to chronic cholecystitis. Similar findings were observed in literature.…”

Section: Calculous Cholecystitissupporting

confidence: 92%

Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

Singh

Goel

2021

Int Surg J

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Background: Surgery in chronic cholecystitis is very challenging because of inability to hold the gall bladder, dense adhesions, frozen Calot’s triangle and difficulty in applying clips. Precise and meticulous dissection is required to establish critical view of safety. There is no consensus among surgeons about appropriate intraoperative steps in difficult gall bladder (GB) surgery. The authors aim to present various intraoperative difficulties and strategies to overcome them. Methods: A prospective study of 81 patients of chronic cholecystitis was done in our institution. They were divided in two groups. Group A in which surgery could be done easily. Group B in which surgery was difficult and different intraoperative strategies were applied to overcome them. Results: Total 42 patients were included in group A and 39 patients in group B. Various difficulties encountered while performing laparoscopic cholecystectomy in group B were adhesions (53.8 %), inability to grasp the fundus of GB (15.3%), frozen Calot’s triangle (15.3%), inability to grasp the Hartmann’s pouch (12.8%) and cystic duct edema (2.5%). Conclusions: Intraoperative technique of identification of Rouviere′s sulcus first, followed by high peritoneal incision on the GB body. Subsequently blunt dissection of Calot’s triangle using gauze piece and hydro dissection by suction irrigation canula ventral to the sulcus. It created a retro gall bladder tunnel safely. It established the critical view of safety in all our cases.

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“…Most of these transformations were due to inability to identify the anatomy so they did fundus first open Cholecystectomy or partial Cholecystectomy in these patients (Agarwal et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Difficult Laparoscopic Cholecystectomy

Alhamid¹

2019

GJHS

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Laparoscopic cholecystectomy is as much easy procedure as difficult one. Surgeon should consider every case as his first one. Intraoperative complications are common while transformation to open surgery should be always in consideration. Transformation to open cholecystectomy isn't a sign of lack of experience, rather it is a proof of surgeon cleverness and an evidence of professional competence as it could keep our patient away from life-threatening complications in difficult situations. Predictive factors for difficulty vary from male patient, repeated acute attacks, history of obstructive jaundice, presence of abnormal anatomical or pathological findings, and adhesions. The aim of this study was to assess some preoperative causes namely by history, clinical examination and, radiological data which can dependably anticipate the odds of troublesome laparoscopic Cholecystectomy or alteration to open Cholecystectomy .1005 patients experienced laparoscopic cholecystectomy 171 of them were difficult cases (10.05%). Transformation rate in our study is within the lower limits and accepted internationally. Dense fibrous adhesion and bleeding are the main causes of transformation. History of acute cholecystitis is separate hazard factor for transformation from laparoscopic to open procedure. Gender and age are also showing increasing rate of transformation. Results shown bile duct damages may evaded even with nearness of hazard factors as anatomical variations from the of biliary channels, intense cholecystitis, extreme endless fibrosis, affected stones inside Hartmann pocket, and short cystic pipe during laparoscopic cholecystectomy by careful watching and wise decision of transformation whenever surgeon feels risk of major complication in case of proceeding in laparoscopic technique. Mortality not encountered directly through the procedure or in short post-operative period but as sequel of complicated cases. Authors proposes that change of the laparoscopic cholecystectomy isn't really a disappointment of the specialist, as usually explained, yet is a lifesaving method as delineated by the results of the study. The experience of the operating surgeon assumes an essential function on this subject.

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Study of 292 patients for prediction of difficult laparoscopic cholecystectomy using detailed history, clinical and radiological parameters

Cited by 4 publications

References 10 publications

The Clinical Features, Ultrasonographical and Histopathological Findings in Cholelithiasis

The Clinical Features, Ultrasonographical and Histopathological Findings in Cholelithiasis

Intraoperative strategies to overcome difficulties in laparoscopic cholecystectomy for chronic calculous cholecystitis

Difficult Laparoscopic Cholecystectomy

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