Preoperative indicators of technically difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

Background
Laparoscopic cholecystectomy (LC) has rapidly become the operation of choice for routine gallbladder (GB) removal. The purpose of this study is to provide preoperative indicators of a technically difficult LC based on various preoperative clinical and ultrasonographic predictors.
Patients and methods
This study was conducted in the General Surgery Department, Ohud General Hospital, Al Madinah Al Munawarah, Saudi Arabia, for 280 patients with diagnosis of gallstones confirmed by abdominal ultrasonography and subjected to LC. The technical difficulty of the surgical procedure was assessed postoperatively (either easy, difficult, or very difficult) based on operative time (min), spillage of bile and/or stones, bile duct injury, and the need for conversion to open surgery.
Results
The present study found that old age; male sex; previous history of acute cholecystitis or acute pancreatitis; history of previous abdominal surgery; urgent surgery after 72 h of the onset of symptoms in acute cholecystitis; morbid obesity; ultrasonographic findings including increased of GB wall thickness, impacted stones, sonographic Murphy’s sign, and pericholecystic fluid collection; and palpable GB increase the technical difficulty of LC. Conversion to open cholecystectomy was seen in only one patient.
Conclusion
Clinical and radiological patient characteristics are good preoperative predictors for the technical difficulty of LC and can help the surgeon to anticipate the risk for intraoperative complications and the possible need for conversion to open cholecystectomy.