Prediction of Difficult Laparoscopic Cholecystectomy during the First Conversation with the Patient

Abstract

Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard now for symptomatic cholelithiasis. Any unexpected turn of events intra-operatively has significant implications which get multiplied many fold due to high number of procedures. If degree of technical difficulty could be predicted before starting the procedure, concerned team can be better prepared and adverse outcomes can be potentially minimised or forestalled. Aim: To study clinical factors responsible for technically difficult laparoscopic cholecystectomy during the first visit of the patient to outdoor. Materials and Methods: This prospective analytical study, based on convenient sampling method, was used to select 125 patients sequentially, who underwent LC. Difficulty assessment was done by a Likert type questionnaire. Weighted Difficulty Score (WDS) was calculated and compared against pre-operative parameters. Results: Difficulty of doing surgery increased with age, history of diabetes mellitus and hypertension and obesity. No difference was found in difficulty score for gender and previous history of surgery. Recurrent cholecystitis, prior-hospitalisation, length of hospital-stay and duration since first episode predicted a difficult LC but not duration since last episode. Icterus and palpable gall bladder were also found to increase the difficulty but presence of tenderness and Murphy’s sign had no relation with the difficulty score. Conclusion: Our results demonstrate that difficult LC can be predicted based on parameters on history and physical examination alone at the first visit of the patient to OPD. Both the patient and surgical team can, therefore, be better prepared for the possible complications and conversions in an environment of confidence and mutual trust.

Keywords

• difficult
• laparoscopic
• weighted difficulty score