A Prospective Study on Pre-Operative and Intra Operative Factors Stratifying the Grade of Difculty In Laparoscopic Cholecystectomy in Tertiary Care Centre

Abstract

 Introduction: Laparoscopic cholecystectomy (LC) is a common minimally invasive surgery for gallstones, yet complexities arise due to anatomical variations and inflammation, sometimes requiring conversion to open cholecystectomy (OC). Predicting LC's difficulty can help surgeons anticipate challenges, aiding in strategic planning and improving patient safety by ensuring appropriate preparations are in place, potentially reducing procedure time and resource use while enhancing overall surgical outcomes. Objective: This study aims to evaluate preoperative and intraoperative factors that influence the difficulty grade in LC and to develop a predictive scoring system for assessing LC complexity. Methods: A prospective study was conducted on 81 patients at Jorhat Medical College and Hospital. Demographic, clinical, biochemical, and radiological data were collected preoperatively. Intraoperative difficulty levels were documented, and a predictive scoring system was developed based on correlations between preoperative indicators and intraoperative challenges. Results: The patient cohort had a mean age of 41-50 years, with a higher prevalence in females (70.4%). Most patients reported right hypochondrial pain, and comorbidities included diabetes (13.6%) and hypertension (16%). Ultrasound findings revealed multiple calculi in 55.6% and gallbladder wall thickening in 24.7%. Predictive scores correlated strongly with intraoperative difficulty grades, with higher scores indicating greater surgical challenges (r = 0.810, p < 0.01).Adhesions were present in 32.5% of cases, and 8.8% required conversion to OC. Conclusion: The study validates a predictive scoring system for LC complexity, integrating age, sex, BMI, and gallbladder characteristics as significant indicators. This approach aids in anticipating difficult cases, allowing for resource optimization and enhanced patient outcomes. Further research with larger samples is recommended to refine the scoring model.