Abstract

Introduction: Laparoscopic cholecystectomy (LC) has become the gold standard treatment for the management of symptomatic gall stone disease but a small yet significant number of LC procedures turn out to be difficult during the procedure. Knowledge of factors that can help in predicting the difficulty can help in better preoperative planning.
Aim: To develop and validate a scoring method to predict difficult and very difficult LC preoperatively.
Materials and Methods: This was a retrospective study conducted on medical records of 122 patients with gall stone disease. A quantitative tool based on age, gender, hospitalization history, the clinical and sonographic profile was designed to capture relevant information from these 122 patients postoperatively and was analysed. There was a total score of 21 from history, clinical, sonological findings. A score up to 7 was predicted as easy, 8–14 as difficult and > 14 as very difficult. The proposed scoring was compared against the laparoscopic difficulty criteria suggested by Randhawa and Pujahari. Data were analyzed using SPSS 21.0 version. Chi-square test and Independent samples ‘t’-test were used to compare the data.
Results : History of hospitalization (p < 0.001), history of ERCP with or without stenting(p < 0.001), BMI >27.5 kg/m2 (p = 0.017), abdominal scar (p=0.001), palpable gall bladder(p < 0.001), thickened wall of the gall bladder(p = 0.010), Pericholecystic collection (p=0.005) and raised ALP (p = 0.002) were found to be significantly contributing in predicting the outcome of surgery.
Conclusion: The proposed scoring system was effective and can be helpful in diagnosing preoperatively into easy, difficult and very difficult cases

Key words: Difficult Laparoscopic Cholecystectomy, scoring system, conversion to open cholecystectomy