The pre-operative predictive model for difficult elective laparoscopic cholecystectomy: A modification

Tongyoo, Assanee; Chotiyasilp, Parm; Sriussadaporn, Ekkapak; Limpavitayaporn, Palin; Mingmalairak, Chatchai

doi:10.1016/j.asjsur.2020.11.018

Cited by 12 publications

(28 citation statements)

References 16 publications

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“…It has been suggested that the reason why difficult cholecystectomy is more common in men is the fact that men can tolerate the symptoms caused by gallstones more than women, and that, as a result, they apply to a physician late with a more advanced disease picture (1,6,11). Similarly, in our study, the male gender was found to be a risk factor for difficult elective LC.…”

Section: Discussionsupporting

confidence: 67%

“…In some studies, advancing patient age has been defined as a predictor for difficult cholecystectomy, as it may cause an increase in the number of cholecystitis attacks (1,11). In our study, as the patient's age was taken as a cut-off 50, it was not found to be a risk factor for difficult elective LC.…”

Section: Discussionmentioning

confidence: 52%

“…Initially, the conversion from laparoscopy to open and long operation times were defined as difficult laparoscopic cholecystectomy criteria. With the scoring systems developed in recent years, the LC difficulty level has been standardized (1,9). The MNS, which we used in our study, is an easily applicable intraoperative difficulty score, and it was defined by Nassar et al in 1996 and its reliability has been demonstrated in studies (10)(11)(12).…”

Section: Discussionmentioning

confidence: 99%

“…Laparoscopic cholecystectomy (LC), which is the gold standard in the treatment of gallstones disease, is globally the most frequently performed surgical procedure (1,2). In line with the increasing number of laparoscopic cholecystectomies, there has been an increase in bile duct injuries.…”

Section: Introductionmentioning

confidence: 99%

“…The most widely accepted and recommended method is the Critical View of Safety (CVS) technique, which was described by Strasberg in 1995 (1,3). Preoperative prediction of difficult cholecystectomy in patients who will be planned for laparoscopic cholecystectomy, informing the patient and their relatives about possible complications, and the surgeon's preparation of an operation plan in advance is vital to reduce the rate of mortality and morbidity (1,6).…”

Section: Introductionmentioning

confidence: 99%

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Predictive factors and importance of Critical View of Safety in difficult elective laparoscopic cholecystectomy

KAR¹,

ATAY²

2022

J. Exp. Clin. Med.

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Knowing the surgical anatomy and related variations, revealing the factors that indicate difficult cholecystectomy, knowing and applying various safe surgical cholecystectomy techniques and guidelines recommended to prevent injuries can prevent complications. This study, it is aimed to evaluate the preoperative factors that will predict difficult elective cholecystectomy. We retrospectively analyzed the data of patients treated for cholelithiasis by an experienced hepatobiliary surgeon or under his supervision between March 2018 and March 2020. Clinical, laboratory, and imaging data obtained from patients' files were evaluated. According to the Modified Nassar Scale (MNS), 140 (79.5%) patients were considered grade 1-2 (easy) and 36 (20.5%) grade 3-5 (difficult) patients within the framework of intraoperative findings. Critical View of Safety was successfully performed in 170 (96.6%) of the patients. Converting laparoscopic cholecystectomy to open was performed in two (1.1%) patients who had an MNS of 4 and 5. The most common comorbidity was hypertension. Male gender, previous cholecystitis and ERCP, and increased gall bladder wall thickness from preoperative USG findings are independent risk factors for difficult cholecystectomy in patients scheduled for laparoscopic cholecystectomy. In addition, it should be kept in mind that LC can be difficult in patients with hypertension and coronary artery disease.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 52%