FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY
Keywords:Cholelithiasis, Laparoscopic cholecystectomy, Risk factor
Laparoscopic cholecystectomy has become the standard operative procedure for cholelithiasis, but there are still some patients requiring conversion to open cholecystectomy, mainly because of technical difficulty.
To identify the prediction of difficult laparoscopic cholecystectomy.
Materials and Methods
Preoperative clinical, laboratory, and radiologic parameters of 249 patients, who underwent laparoscopic cholecystectomy, were analyzed for their technical difficulty. Parameters (male sex, abdominal tenderness, previous upper abdominal operation, sonographically thickened gallbladder wall, age over 65 years, preoperative diagnosis of acute cholecystitis, history of ERCP) were found to have significant effect in multivariate analysis.
Overall 54 operations (21.7%) were difficult; 36 operations (14.5%) took long time and 18 patients (7.2%) required conversion to open cholecystectomy.
Conversion risk can be predicted to some extent. Patients having high risk may be informed and scheduled appropriately. An experienced surgeon has to operate on these patients, and he or she has to make an early decision to convert in case of difficulty.
Russell R.C.G. The gall bladder and bile ducts. In; Russell RCG Williams N S, Bulstrode CJK. Baily and Love short practice of surgery, 26th edition, chapter 67. London, Arnold Publisher Company, 2013: 1106- 11.
Sengül S, Çetinkünar Çiftçi E, Bilgen K, Isik S, Colhan I, et al. Evaluation of potential intraoperative technical difficulties with ultrasonography before laparoscopic cholecystectomy. Eur J Surg Sci. 2012; 3:15-21.
Lam CM, Murray FE, Cuschieri A. Increased cholecystectomy rate after the introduction of laparoscopic cholecystectomy in Scotland. Gut. 1996; 38:282–284.
The southern Surgeons Club, Meyers WC (1991) A prospective analysis of 1518 laparoscopic cholecystectomy. N Engl J Med 324:1073–1078.
Karadeniz E, Özogul B, Yildirgan MI, Kisaoglu A, Atamanalp S. Determination of eligibility for laparoscopic cholecystectomy of elective patients. J. Exp. Clin. Med. 2013; 30: 331-334.
Vivek MAKM, Augustine AJ, Rao R. A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. J Min Access Surg. 2014; 10: 62-67.
Sugrue M, Sahebally SM, Ansaloni L, Zielinski MD. Grading operative findings at laparoscopic cholecystectomy- a new scoring system. World J Emerg Surg. 2015; 10: 14.
Gupta N, Ranjan G, Arora MP, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013; 11: 1002-1026.
Singh K, Ohri A. Difficult laparoscopic cholecystectomy: a large series from North India. Ind J Surg. 2006; 68:205-208.
Nachnani J, Supe A. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian journal of gastroenterology: official journal of the Indian Society of Gastroenterology. 2005; 24:16–18.
Lal P, Agarwal PN, Malik VK, Chakravarti AL. A difficult laparoscopic cholecystectomy that requires conversion to open procedure can be predicted by preoperative ultrasonography. JSLS: Journal of the Society of Laparoendoscopic Surgeons/Society of Laparoendoscopic Surgeons. 2002;6:59–63.
Randhawa, Jaskiran S., and Aswini K. Pujahari. Preoperative prediction of difficult lap chole: a scoring method. Indian Journal of Surgery 71.4 (2009); 198-201.
Kama NA, Kolongue M, Doganay M, Reis E, Atle M, Dolapiu M. Risk score conversion from laparoscopic to open cholecystectomy. Am J Surg.2001; 181:520–525.
Kanaan SA, Murayama KM, Merriam LT, Dawes LG, Puystowsky JB, Reye RB, Jochl RJ. Risk factor for conversion of laparoscopic to open cholecystectomy. J Surg Res.2002; 106:20–24.
Heng-Hui Lein MD, Ching-Shui Huang. Male gender: Risk factor for severe symptomatic cholelithiasis. World J Surg.2002; 26:598–601.
Russell JC, Walsh SJ, Fourquet LR, Mattie A, Lynch J. Symptomatic cholelithiasis: a different disease in men? Ann Surg.1998; 277:195–200.
Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg.2002; 184:254–258.
Schrenk P, Woisetschlager R, Reiger R, et al. Preoperative ultrasonography and prediction of difficulties in laparoscopic cholecystectomy. World J Surg. 1998; 22:75–77.
Fried GM, Barkun JS, Sigman HH, Joseph L, Uas D, Garzon J, Hinchey EJ, Meakins JL. Factors determining conversion to laparotomy in patient undergoing laparoscopic cholecystectomy. Am J Surg. 1994; 167:35–41.
Ahmet Alponat, Cheng K, Bee C Koh, Andrea R, Peter MY Goh. Predictive Factors for conversion of laparoscopic cholecystectomy. World J Surg. 1997; 21:629–633.
Walnerhanssen BK, Ackermann C, Guenin MO, Kern B, Tondelli P, von Felie M, Peterli R. Twelve years of LC. Chirurg. 2005; 76(3):263–269.
Rao, Ranjith, Sunil Kumar Math, and N. Sathyanarayana. "Pre-Operative ERCP is a Significant Difficulty Predictor ForLaparoscopic Cholecystectomy–An Analysis. IOSR Journal of Dental and Medical Sciences (IOSR-JDMS), 2015; 1.14: 64-69.
Copyright (c) 2017 Deari Ahmed Ismaeil , Barham M. M. Salih and Karzan Seerwan Abdulla
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.