Assessment of preoperative factors for challenging laparoscopic cholecystectomy

Abstract

Aim:Cholecystectomy is one of the most widely practiced surgery around the world. In recent studies, various parameters such as age, sex, BMI, history of previous abdominal surgery, ultrasonography findings of gall bladder wall thickness, contracted gall bladder, peri-cholecystic fluid, stone size, and haematological findings such as raised TLC, alkaline phosphatase, and liver enzymes were added to predict difficult Laparoscopic Cholecystectomy.The aim of present research was to see if such factors can be used to assess challenging laparoscopic cholecystectomy and conversion before surgery.Methodology:Patients who reported to the OPD with a symptomatic history of gallstone were involved in the study, and after clinical examination, routine tests, and abdominal ultrasonography, elective surgery was performed. The research included patients of all ages and both genders.Before the procedure, all patients' medical records were reported in detail, and demographic data likesex, age, height, weight, and body mass index (BMI) were measured, hematologicalblood tests were also performed,TLC, alkaline phosphatase, S.Bilirubin, and enzymes of liver were all provided special attention. Along with abdominal ultrasonography various other parameters were registered. Patients were split into two classes after surgery: who had a good laparoscopic cholecystectomy and those who wanted an open cholecystectomy. Most of those patients underwent laparoscopic cholecystectomy. The data was analysed by using SPSS23.0. Results:Conversion/difficult laparoscopic cholecystectomy was associated with age > 50 years. The sensitivity was kept 95.9%, and the optimistic predictive value was 95%. The conversion rate for male was 27.7%, while for the female 8.5%. BMI > 30 kg/m2 was found to be related with a higher chances of conversion to open cholecystectomy. The positive predictive value was 94.1%, and the sensitivity was 96.9%. The conversion rate between cases with BMI >30 kg/m2 was 70%, with a p value of 0.000.Conclusion:Age, sex, obesity, a raised total leucocyte count, history of surgery for upper abdomen and other risk factors and predictors for conversion to open cholecystectomy include among others.