CORRELATION BETWEEN PREOPERATIVE VARIABLES WITH INTRAOPERATIVE SCORING SYSTEM TO PREDICT DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY
Major (Dr.) Lalit Tomar, DNB (Surg); Major (Dr.) Vijay Singh, DNB (Anaes); Lt Col (Dr.) Shibu Sasidharan*, MD, DNB (Anaes), MNAMS; Surg Lt Cdr (Dr.) Abdul Nasser, DNB (Anaes)
Background: Laparoscopic Cholecystectomy is the gold standard procedure for symptomatic Cholelithiasis. However, in some patients, this laparoscopic approach for cholecystectomy may be technically difficult due to various factors. If these factors can be identified pre operatively or early during the surgery, it can reduce the incidence of certain avoidable intra operative complications associated with the surgery. With this background, this study was conducted with an aim to determine preoperative variables that are associated with difficult laparoscopic cholecystectomy based on intraoperative scoring system. Methodology: The study was conducted on 150 consecutive patients with gall stones disease posted for elective laparoscopic cholecystectomy and performed by senior surgeon with experience of >100 laparoscopic cholecystectomy (LC) at tertiary care service hospital, India. Various preoperative variables (history, clinical and USG) were correlated with intraoperative scoring system to find, which of the preoperative variables are significantly associated with a DLC. Intraoperative score of 5 or more out of 10 was taken as criteria for predicting DLC. Results: Laparoscopic cholecystectomy was performed on 150 patients, out of which, 122 (81.3%) were female and 28 (18.7%) males. There was a total of 38 cases (25.3%) which had a DLC with a conversion rate of 2%. Most common age group underwent laparoscopic cholecystectomy was 30-40yrs. There was an increasing trend observed for difficult cases with advancing age which was statistically significant with a P value of 0.035. Gender, obesity (BMI>30Kg/m2) and comorbidity do not show much statistical significance in predicting a difficult surgery. Clinically positive finding in the form of palpable GB or right hypochondrium tenderness strongly signifies a DLC and intra operative difficulty level was higher in patients with a thickened gall bladder wall, impacted gallstone, multiple stones and presence of contracted/overdistended GB on ultrasonographic examination. Conclusion: It is possible to predict DLC using history, clinical and USG findings. So, patients may be assessed preoperatively for the difficulty level based on various preoperative parameters which will help the surgeon in anticipating the difficulty level and prepare accordingly to deal appropriately with avoidable complications.
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