Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

  • Mukund Raj Joshi Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
  • Tanka Prasad Bohara Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
  • Shail Rupakheti Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
  • Anuj Parajuli Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
  • Dipendra Kumar Shrestha Department of Surgery, Lumbini Medical College and Teaching Hospital, Palpa, Nepal.
  • Dimindra Karki Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
  • Uttam Laudari Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal.
Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis.

Abstract

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively.

Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment.

Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883).

Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.

Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis.

Published
2015-12-31
How to Cite
Joshi, M., Bohara, T., Rupakheti, S., Parajuli, A., Shrestha, D., Karki, D., & Laudari, U. (2015). Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy. Journal of Nepal Medical Association, 53(200), 221-226. https://doi.org/10.31729/jnma.2734
Section
Original Article