Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy.

ABSTRACT

Laparoscopic cholecystectomy is the gold standard for the symptomatic gall stone disease. Sometime conversion to an open procedure may be necessary due to some difficulties encounter during laparoscopic cholecystectomy. The aim of this study is to determine whether variability of some of pre-defined pre-operative factors may have some bearing of the degree of difficulties that may be encounter during laparoscopic cholecystectomy. Seven parameters Age, Sex, BMI, ASA class, Hypertension, Diabetes and Previous Abdominal Surgery were studied in 112 patients in our department of Surgery, I.P.G.M.E&R and S.S.K.M. Hospital, Kolkata. Univariate analysis was performed using the chi-squared test to determine the factors that were associated with difficult LC, and odds ratios and their 95% confidence intervals were calculated. In 25(22.32%) patients pre-operative difficulties were encountered and out of these 6(5.35%) required conversion to open procedure. ASA class (OR 6.81, 95%CI 2.386-19.438, p <0.001), Hypertension (OR 7.76, 95%CI 2.651-22.706, p <0.001) and Diabetes mellitus (OR 4.26, 95%CI 1.2371-14.692, p 0.025) were found to be statistically significant predictor of difficult laparoscopic cholecystectomy .However, age (p 0.247), male sex (p 1.00), BMI (p 0.161) and past abdominal surgery (p 0.115) were not found to be statistically significant variables. Difficult laparoscopic cholecystectomy can be predicted pre-operatively and that may help in proper pre-operative planning and counseling to reduce overall complications and morbidity.