Study of a Scoring Method to Predict Difficult Laparoscopic Cholecystectomy

Nikhil Gupta, MS, MRCS, FAIS, FMAS, Gyan Ranjan, MBBS, M P Arora, MS, Poras Chaudhary, MS, Arun Kapur, MS, MRCS

LADY HARDINGE MEDICAL COLLEGE AND ASSOCIATED DR RAM MANOHAR LOHIA HOSPITAL, DELHI, INDIA

Introduction: LC is one of the most common laparoscopic procedures being performed by the general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system. Though most of these risk factors were studied previously but these studies were mostly retrospective.

Materials: This prospective study was done in department of surgery, Lady Hardinge Medical College and associated Dr Ram Manohar Lohia Hospital, Delhi, India. The parameters included in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, palpable gall bladder, wall thickness of gall bladder, Pericholecystic collection and impacted stone. A total of 70 patients were included in the study.

Results: We found that history of hospitalization, palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Sensitivity and specificity of this preoperative scoring method were found to be 95.74% and 73.68% respectively. Positive predictive values of this scoring method were 90% and 88% for easy and difficult cases respectively. Area under ROC curve was 0.86. Conversion rate from laparoscopic to open cholecystectomy was 4.28%.

Conclusion: With the help of accurate prediction, high risk patient may be informed before hand and they may have a chance to make arrangements. Surgeons also may have to schedule the time and team for the operation appropriately.

Session: Poster Presentation

Program Number: P324