Difficult Laparoscopic Cholecystectomy Prediction by the Use of Clinical Parameters
Laparoscopic cholecystectomy has now replaced open cholecystectomy for the treatment of gallbladder pathologies (stones, polyps) , However, Laparoscopic cholecystectomy may be considered ‘difficult’ by various problems encountered during surgery, such as difficulties in accessing the peritoneal cavity, creating a pneumoperitoneum, dissecting the calot’s triangle, extracting the gall bladder from the liver bed, or the excised gall bladder removal from the port.
This study was cond ucted to identify and evaluate whether preoperative clinical parameters in patient undergoing laparoscopic cholecystectomy for cholelithiasis can predict the levels of intra- operative difficulties.
PATIENTS AND METHODS:
100 patients who underwent laparoscopic cholecystectomy. All the patients were with symptomatic gallstone disease. Detailed clinical history, examination and Investigations were taken. Prospective analyses of different preoperative (patient-related) clinical parameters contributing to difficult laparoscopic cholecystectomy were performed. The study was performed in Al-Imamain Al-Kadhimain Medical City between October 2015 to October 2016.
OF 100 patients with laparoscopic cholecystectomy, 33 patients (33%) developed difficulties during operation. Factors associating difficult laparoscopic cholecystectomy included; male gender, wall thickness more than 4 mm, previous upper abdominal surgery and BMI more than 35 and the most common (specific) type of intraoperative difficulties was bile leak due to gall bladder perforation and liver bed affecting 10 patients out of the 33 difficult cases (10%) from the total cases and the least difficulty was conversion to open cholecystectomy occurred in 2 patients (2%).
The prediction of difficult laparoscopic cholecystectomy by the use of clinical parameters showed that male gender, wall thickness above 4mm, and history of previous upper abdominal surgery are statistically significant predictive factors.
Knowledge of these predictive factors preoperatively may help in improving patient safety with
involvement of experienced laparoscopic surgeon who could better anticipate intraoperative risk & technical difficulty encountered while operating on these patients.