Predictors of Difficult Laparoscopic Cholecystectomy and their Outcomes in a Tertiary Care Center—A Prospective Observational Study

Abstract

BACKGROUND: Cholelithiasis is the most common biliary pathology, with a prevalence of 10%-15%. It is symptomatic in approximately 1%-6 % of patients. In about 5%-10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gall bladder.

OBJECTIVE: To evaluate the pre-operative predictors of difficult laparoscopic    Cholecystectomy based on ‘Risk Score for Conversion from Laparoscopic cholecystectomy to Open cholecystectomy (RSCLO) and to evaluate the outcomes of these patients.

METHODS: The source of data for the present study comprised of 100 patients admitted to Victoria Hospital and Bowring & Lady Curzon Hospital, BMCRI, Bengaluru, from January 2023 to May 2024. The cases were confirmed by USG. Following risk factors were recorded; age > 50 years, male sex, previous abdominal surgery, abdominal tenderness, USG findings which includes gall bladder wall thickening, acute cholecystitis features such as impacted stone, pericholecystic fluid collection. Each risk factor was given a score.

STATISTICS: Fischer exact test was used to find the significant association of findings of preoperative score with per-operative outcome.

RESULTS: Out of the risk factors, USG detected gall bladder thickness, abdominal tenderness and acute cholecystitis features were significant predictors of difficult laparoscopic cholecystectomy (p value <0.005).