The PRE-OPERATIVE PREDICTORS FOR INTRAOPERATIVE DIFFICULTY IN LAPAROSCOPIC CHOLECYSTECTOMY: PROSPECTIVE OBSERVATIONAL STUDY
Pre operative predictors for Laproscopic Cholecystectomy
DOI:
https://doi.org/10.15713/ins.bhj.180Keywords:
Cholelithiasis, cholecystitis, difficult Laparoscopic Cholecystectomy, frozen calots triangle,aberrant bile ducts, iatrogenic bile duct injuryAbstract
OBJECTIVE :- To find Preoperative predictors for intraoperative difficulty in Laparoscopic Cholecystectomy.
METHOD :-
This was an Observational study of 150 patients at a tertiary health care center , done over a period of two years from March 2022 to March 2024.
Inclusion criteria- A Prospective observational study will be done in 150 patients of elective Laparoscopic Cholecystectomy, coming to a tertiary health care center,
admitted and operated by a constant team at the aforementioned center. The
average time taken by the said team to operate Uncomplicated Laparoscopic
Cholecystectomy is about 60 mins.
Exclusion criteria-
i. The cases of LC conversion to open cholecystectomy due to equipment failure and surgery in emergency setting
ii. Also, in cases of
1. Cholecystic intestinal fistula
2. Carcinoma gallbladder
3. GB perforation / peritonitis
4. Choledocholithiasis needing choledochotomy
Subject withdrawal criteria- Unwillingness on part of the patient is the only withdrawal criteria.
All patients who were operated were observed for the following preoperative factors
1. History
a. History of attack of Acute Cholecystitis
b. History of ERCP
c. History of previous abdominal surgery
2. Clinical examination
a. BMI <25 or >25
b. Palpable gallbladder
c. P/A - Tenderness/ Guarding
3. Ultrasonography findings
a. Wall thickness >4mm
b. Pericholecystic collection
c. Impacted stone
d. CBD dilation
RESULT :-
- The pre operative score was determined to be easy in 33 males and 47 females and postoperatively 29 males (87.87%) were found to be easy cases and all 47 females (100%) were categorised under Easy LC.
- The pre operative score was determined to be moderate in 23 males and 22 females and postoperatively all 23 males (100%) were found to be moderate LC cases and 19 females (86.36%) were categorised under Moderate LC.
- The pre operative score was determined to be difficult in 13 males and 12 females and postoperatively 17 males were found to be difficult cases and 15 females were categorised under Difficult LC.
CONCLUSION :-
Our study has shown that it is possible to predict difficulty pre operatively during laparoscopic cholecystectomy and the chances of conversion to open cholecystectomy can be predicted. In our study we found history of acute cholecystitis, symptoms and signs of acute cholecystitis, male gender, contracted GB, GB wall thickness > 4mm, presence of Pericholecystic fluid and history of previous abdominal surgery and ERCP to be significant predictors of difficulty in laparoscopic cholecystectomy.
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