Predicting the risk factors of difficult laparoscopic cholecystectomy step by step

Yassein, Taha; Iyoab, Islam; Sallam, Ahmed; Gomaa, Manal; Sadek, Amr; Osman, Maher; Ibrahium, Tarek; Aziz, Amr Mostafa

doi:10.4103/ejs.ejs_8_20

Predicting the risk factors of difficult laparoscopic cholecystectomy step by step

Authors

Abstract

Background
Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic gallstones. It has replaced open cholecystectomy as the therapeutic modality in the treatment of cholelithiasis.
Aim
The aim of the study is to determine the predictive factors for difficult LC step by step using clinical and ultrasonography parameters.
Patients and methods
This is a prospective study conducted on 75 patients suffering from chronic calculous cholecystitis and planned for LC at the National Liver Institute, Menoufia University . All patients were compared according to demographic data, clinical data, laboratory profile, abdominal ultrasound result, and operation data.
Results
Difficult gallbladder (GB) bed dissection was found significantly related to patients with a history of acute cholecystitis, positive Murphy’s sign, history of endoscopic retrograde cholangiopancreatography (ERCP) and GB wall thickness more than 3 mm during inspection. Distended GB and dense adhesions were found statistically significant in increasing the risk of bile and stone spillage during operation. Difficulty of extraction of GB was found in patients with a history of ERCP, distended GB and GB wall thickness more than 3 mm. Risk of conversion to open was found significantly related to patients with a history of biliary pancreatitis and patients with a history of ERCP. Operative time was found prolonged in cases with a history of biliary pancreatitis, history of ERCP, distended GB, multiple stones, and dense adhesions encountered during the first 5 min inspection.
Conclusion
BMI, history of acute attacks, positive Murphy’s sign, history of ERCP, history of biliary pancreatitis, GB wall thickness more than 3 mm, multiple GB stones, and dense adhesion does pose difficulty in various steps during LC. So, preoperative prediction of possible difficulties may help a surgeon in choosing the approach (open/laparoscopic) most suitable for a particular patient, counseling the patient about it.

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