Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters.

BACKGROUND: Pre-operative prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon prepare better for the intra-operative risk and the risk of conversion to open cholecystectomy. METHODS: In 105 eligible patients who underwent LC during May 2001 to January 2003, patient characteristics, clinical history, laboratory data, ultrasonography results and intra-operative details were prospectively analyzed to determine predictors of difficult LC. RESULTS: Of 105 patients, 12 (11.4%) required conversion to open cholecystectomy. Significant predictors of conversion were body mass index> 30 Kg/m2, male gender, past history of acute cholecystitis or acute pancreatitis, past history of upper abdominal surgery, and gall bladder wall thickness exceeding 3 mm. CONCLUSION: Clinical and ultrasonograpic factors can help predict difficult LC and likelihood of conversion of LC to open surgery.