Abstract
Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However conversion is inevitable in difficult cases among all laparoscopic cholecystectomies 1-13% requires conversion to open conversion. Several factors have been implicated with a difficult case, but no reliable criteria are available yet to identify patients preoperatively with a difficult Laparoscopic cholecystectomy in feasibility of Calot’striangle dissection.
Aim: To predict the feasibility of Calot’s triangle dissection outcome by clinico-radiological assessment in easy verses difficult laparoscopic cholecystectomy.
Material and Methods: This was a prospective study conducted from November 2015 to October 2017. Total of 63 patients meeting the inclusion criteria undergone laparoscopic cholecystectomy were included in the study. Following parameters were assessed preoperatively such as BMI, number of attacks of cholecystitis, previous abdominal surgery, total leucocyte count and compare with intraoperative findings as “easy laparoscopic cholecystectomy” and “difficult laparoscopic cholecystectomy”. The statistical analysis was done using Chi- squretest.
Results: Out of 63 patients difficult laparoscopic cholecystectomy was seen in 25 (39.7%) patients and 7 (11.1%) patients required conversion to open cholecystectomy. Significant predictors of difficult and conversion were BMI, TLC, ultrasonographic findings of presence of pericholecystic fluid collection, multiple stone or stones ≥20mm impacted in Hartmann's pouch, adhesion in Calot's triangle and gallbladder perforation.
Conclusion: with preoperative clinical and ultrasonographic parameters, proper patients selection can be made to help predict difficult laparoscopic cholecystectomy and a likelihood of conversion to open cholecystectomy. Patients and relatives can be counseled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.
Keywords: Calot’s Triangle, Cholesystectomy, Laparoscopy, Easy, Difficult, Open Conversion, Ultrasonographic Parameters.
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Corresponding Author
Dr Fakira Mohan Sahu
Post Graduate Student, Department Of General Surgery,
VIMSAR, Burla, Odisha, India
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.33
