STUDY TO ASSSES THE MAJOR PREOPRATIVE PREDICTORS FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

Dr. Ramesh Kaundal, Dr. Sanjeev Gupta, Dr. Seema*, Dr. Vishal Thakur and Dr. Vipul Parmar

ABSTRACT

Background: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for gallstone disease. Though mostly safe occasionally it can be difficult due to various problems faced during surgical procedure. Anticipation of likely difficulty can help in avoiding complications and legal aspect. Methods: With the aim of identifying, comparing various predictors of difficulty and their correlation with likely difficulty this prospective study on 100 patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis was undertaken. Various clinical, sonological predictors were recorded and assessed for intraoperative difficulties and frequency of difficult laparoscopic cholecystectomy was recorded. Results: 100 patients were studied with age ranging from 10-80 years, maximum incidence of difficult LC (36.14%) being in the age group 41-50 years. The time taken for LC increased significantly with increasing age. Gender affects the difficulty i.e. 48.15 % difficulty in male as compared to 24.66% among female patients. Body mass index (BMI) > 25 did not show any significance with difficult cholecystectomy. Previous history of multiple attacks of acute cholecystitis, h/o ERCP with CBD stenting, Upper abdominal surgery, clinically tender palpable GB, USG evidence of contracted/distended GB, impacted stone at GB neck, GB wall thickness >4 mm, multiple stones in GB had increased rate of difficult cholecystectomy and the conversion rate. Conclusions: Clinical and sonological predictors are most reliable factors. Use of good clinical judgment regarding possibility of and likely difficulty along with understanding of available resources is important in making decision in each case.

Keywords: Clinical, Sonological, Difficult laparoscopic cholecystectomy, Predictors.