Prediction of Difficult Laparoscopic Cholecystectomy Based on Clinical and Ultrasonographic Parameters
Background: Cholelithiasis is the most common biliary pathology. The definitive treatment for cholelithiasis is either open/laparoscopic cholecystectomy (LC). The objective of this study was to predict difficulty in doing LC based on clinical and ultrasonographic parameters.
Materials and Methods: A hundred patients admitted with a diagnosis of cholelithiasis in surgical wards in the Department of Surgery, Shyam Shah Medical College and Associated Sanjay Gandhi Memorial Hospital, Rewa, from June 1, 2018, to May 31, 2019, were included in the study. All necessary investigations were carried out. X-ray, ultrasonography (USG) abdomen, and blood investigations were done. Patients underwent LC, and a careful record of pre-operative and post-operative findings was made and carefully filled in the pro forma.
Results: In the present study, body mass index >27.5 kg/m2 (27%) shows a correlation with predicting difficult LC and conversion to open procedure. Clinical parameters such as guarding and rigidity (8%) with mass (12%) were a sign of acute inflammation, associated with ultrasonography findings favor for difficult cholecystectomy. Gallbladder wall thickness (38%) and pericholecystic fluid collection (16%) in USG are strong predictors of difficulty.
Conclusion: Clinical and USG findings help to predict difficulty in laparoscopic cholecystectomy and leading to the conversion of LC to open cholecystectomy
Best Pract Res Clin Gastroenterol 2006;20:981-96.
2. Nidoni R, Udachan TV, Sasnur P, Baloorkar R, Sindgikar V,
Narasangi B. Predicting difficult laparoscopic cholecystectomy based on
clinicoradiological assessment. J Clin Diagn Res 2015;9:PC09-12.
3. Reddy RV, Balamaddaiah G. Predictive factors for conversion of
laparoscopic cholecystectomy to open cholecystectomy: A retrospective
study. Int Surg J 2016;3:817-20.
4. Goyal V, Nagpal N, Gupta M, Kapoor R. A prospective study to predict
the preoperative risk factors for conversion of laparoscopic to open
cholecystectomy. Int J Contemp Med Surg Radiol 2017;2:148-52.
5. Kassa V, Jaiswal R. Assessment of risk factors for difficult surgery in
laparoscopic cholecystectomy. Med Pulse Int Med J 2017;4:258-62.
6. Khandelwal N, Salim M, Gandhi A. Predicting difficult laparoscopic
cholecystectomy based on clinico radiological parameters. Sch J Appl Med
7. Bunkar SK, Yadav S, Singh A, Agarwal K, Sharma P, Sharma AC, et al.
Factors predicting difficult laparoscopic cholecystectomy: A single institution
experience. Int Surg J 2017;4:1743-7.
8. Mudgal MM, Kushwah N, Singh R, Gehlot H. A clinical study to determine
predictive factors for difficult laparoscopic cholecystectomy. Int J Med Sci
Public Health 2018;7:116-20.