Abstract
Background: One of the most common laparoscopic surgeries performed by the general surgeons all over the world is laparoscopic cholecystectomy (LC). Due to various intraoperative difficulties, it is important for a surgeon to evaluate it thoroughly pre-operatively.
Objective: To study the various risk factors and to predict the level of difficulty of laparoscopic cholecystectomy pre-operatively by the use of proposed scoring system.
Materials and Methods: 86 patients fulfilling the inclusion criteria undergoing LC were included in the study. The study was carried out at DVVPF’s Medical college and hospital, Ahmednagar between January 1, 2015, to December 1, 2017.Total maximum pre-operative score was 17 based on parameters as age, sex, BMI, prior attack of acute cholecystitis, palpable gall bladder(GB), abdominal scars, total leucocyte count (TLC) and certain ultrasonographic findings i.e. thickened gall bladder wall, distended or contracted gall bladder, pericholecystic fluid collection, impacted stone and altered hepatic echotexture. Score <5 was predicted as easy, 6-10 as difficult and 11-17 as very difficult. Intraoperative findings of LC were recorded and patients were categorized as easy, difficult and very difficult depending on various factors.
Results: Sensitivity and Specificity of the Dash, Bhondave & Gadekar scoring method was found to be 95.24% and 73.63% respectively and there were no cases with score above 10. According to the Dash, Bhondave & Gadekar scoring method, 76% cases were predicted to be easy out of which 70% turned out to be easy, while 24% cases were predicted to be difficult out of which 16% turned out to be difficult and 5% to be very difficult. Positive predictive value of this scoring method was 92% and 82% for easy and difficult cases respectively. Parameters like prior attack of acute cholecystitis (p<0.0002), palpable gall bladder (p<0.004) and ultrasonographic findings like thickened GB (p<0.00005), distended or contracted gall bladder (p<0.000001), pericholecystic fluid collection (p<0.0002) and impacted stone (p<0.003) were found to be statistically significant in predicting difficult LC.
Conclusion: Various scoring systems are available to predict difficult LC which are cumbersome to implement. We proposeDash, Bhondave&Gadekar scoring system which is easy and statistically reliable to predict difficult cases.
Keywords: Cholecystitis, Laparoscopic cholecystectomy, Parameters, Scoring system.
References
- Ravindra Nidoni, Tejaswini V Udachan, Prasad Sasnur, RamakantBaloorkar, VikramSindgikar, Basavaraj Narasangi. Predicting difficult laparoscopic cholecyst-ectomy based on clinicoradiological assessment. Journal of Clinical and Diagnostic Resarch2015;9(12):09-12.
- Michael J. Zinner, Stanley W. Ashley(eds.).Maingot’s Abdominal Operations. China: The McGraw-Hill Companies, 2013.
- Abdel Baki NA, Motawei MA, Soliman KE, Farouk AM. Preoperative Prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters.JMRI 2006;27(3):102-7.
- Alponat A, Kum CK, Koh BC, Rajnakova A, Goh PM. Predictive factorsfor conv-ersion of laparoscopic cholecystectomy. World J Surg. 1997;21:629-33.
- Ravindra Nidoni, Tejaswini V Udachan, Prasad Sasnur, RamakantBaloorkar, VikramSindgikar, Basavaraj Narasangi. Predicting difficult laparoscopic cholecys-tectomy based on clinicoradiological assessment. Journal of Clinical and Diagnostic Resarch 2015;9(12):09-12.
- Michael J. Zinner, Stanley W. Ashley(eds.).Maingot’s Abdominal Operations. China: The McGraw-Hill Companies, 2013.
- Gadacz TR. Update on laparoscopic cholecystectomy, including a clinical pathway. SurgClin North Am. 2000;80:1127-45.
- Lee NW, Collins J, Britt LD. Evaluation of preoperative risk factors for converting laparoscopic to open cholecystectomy.Am J Surg. 2012;78(8):831-33.
- Hussain A. Difficult laparoscopic cholecystectomy: current evidence and strategies of management. SurgLaparosc Percutan Tech 2011;21(4):211-17.
- O’Leary DP, Myers E, Waldron D, Coffey JC.Beware the cobtracted gallbladder- Ultrasonic predictors of conversion. Surgeon.2013;11:187-90.
- Nikhil Agarwal, Sumitoj Singh and Sudhir Khichy. Preoperative Prediction of Difficult Laparoscoipic Cholecystectomy: A Scoring Method. Niger J Surg. 2015;21(2):130-33.
- Nikhil Gupta, Gyan Ranjan, M.P.Arora, BinitaGoswami, Poras Chaudhary, ArunKapur, Rajeev Kumar, Tirlok Chand. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. International Journal of Surgery 2013;11:1002-06.
- Bouarfa L, Schneider A, Feussner H, Navab N, Lemke HU, Jonker PP, et al. Prediction of intraoperative complexity from preoperative patient data for laparoscopic cholecystectomy. ArtifIntell Med 2011;52(3):169-76.
- Majeski J. Significance of preoperative ultrasound measurement of gall bladder wall thickness. Am Surg 2007;73(9):926-9.
- Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184 (3):254-58.
- Acharya A, Adhikari SK. Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy. Postgra-duate Medical Journal of NAMS.2012;12(1):45-50.
- Nikhil Gupta, Gyan Ranjan, M.P.Arora, BinitaGoswami, Poras Chaudhary, ArunKapur, Rajeev Kumar, Tirlok Chand. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. International Journal of Surgery 2013;11:1002-06.
- Nikhil Agarwal, Sumitoj Singh and Sudhir Khichy. Preoperative Prediction of Difficult Laparoscoipic Cholecystectomy: A Scoring Method. Niger J Surg. 2015;21(2):130-33.
- Hussain A. Difficult laparoscopic cholecystectomy: current evidence and strategies of management. Surg Laparosc Percutan Tech 2011;21(4):211-17.
- Nachnani J, Supe A. Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. Indian J Gastroenterol 2005;24(1)16-8.
- Nikhil Gupta, Gyan Ranjan, M.P.Arora, BinitaGoswami, Poras Chaudhary, Arun Kapur, Rajeev Kumar, Tirlok Chand. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. International Journal of Surgery 2013;11:1002-06.
- Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: A Scoring method.Indian J Surg. 2009;71:198-201.
- Nikhil Gupta, Gyan Ranjan, M.P.Arora, Binita Goswami, Poras Chaudhary, Arun Kapur, Rajeev Kumar, Tirlok Chand. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. International Journal of Surgery 2013;11:1002-06.
- Ravindra Nidoni, Tejaswini V Udachan, Prasad Sasnur, RamakantBaloorkar, VikramSindgikar, Basavaraj Narasangi. Predicting difficult laparoscopic cholecys-tectomy based on clinicoradiological assessment. Journal of Clinical and Diagnostic Resarch 2015;9(12):09-12.
- Fried GM, Barkum JS, Sigman HH, Joseph L, Clas D, Garzon J, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecy-stectomy. Am J Surg. 1994;167:35-9.
- Majeski J. Significance of preoperative ultrasound measurement of gall bladder wall thickness. AmSurg 2007;73(9):926-9.
- Carmody E, Arenson AM, Hanna S. Failed or difficult laparoscopic cholecystectomy: casn preoperative ultrasonography identify potential problems. J Clin Ultrasound 1994;22(6):391-96.
- Ravindra Nidoni, Tejaswini V Udachan, Prasad Sasnur, Ramakant Baloorkar, Vikram Sindgikar, Basavaraj Narasangi. Predicting difficult laparoscopic cholecyst-ectomy based on clinicoradiological assessment. Journal of Clinical and Diagnostic Resarch 2015;9(12):09-12.
- Nikhil Gupta, Gyan Ranjan, M.P.Arora, BinitaGoswami, Poras Chaudhary, ArunKapur, Rajeev Kumar, Tirlok Chand. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. International Journal of Surgery 2013;11:1002-06.
- Khan IA, EI-Tinay OE. Laparoscopic cholecystectomy for acute cholecystitis: can preoperative factors predict conver-sion? Saudi Med J 2004;25(3):299-302.
Corresponding Author
Dr S.T.Bhondave
Postgraduate student, Department of General Surgery,
DVVPF’s Medical College and Hospital, Ahmednagar, Maharashtra, India
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.67
