Study of Risk factors predicting difficult Cholecystectomy and conversion from laparoscopic to open Cholecystectomy

Abstract

Background: Laparoscopic Cholecystectomy occasionally can become difficult due to various reasons. Preoperative risk factors which can predict difficult cholecystectomy are advanced age, male sex, high BMI, acute cholecystitis and previous hospitalisation for recurrent attacks, thickened gall bladder wall, impacted stone at neck of gall bladder and previous surgeries on abdomen. If preoperative factors can predict difficult Cholecystectomy, it will be helpful for surgeons to sort out low risk and high risk groups. Low risk group surgeries can be performed by trainees and high risk cases can be performed by more experienced surgeons or at specialized unit. Objective: To identify the risk factors predicting difficult Laparoscopic Cholecystectomy and need for conversion to open Cholecystectomy. Methodology: All the cases admitted for gallstone disease in Department of General Surgery at Hassan Institute of Medical Sciences, Hassan between September 2017 to September 2020 were studied retrospectively. Total of 255 patients met inclusion criteria and underwent LC were included in the study. Details of patients demographics, clinical findings, laboratory Investigations and imaging findings were recorded. Results: In the study 255 subjects who underwent Cholecystectomy were included in the study. In the study 82.3% had easy, 13.4% had difficult, 2% had very difficult and 2.4% underwent conversion to open Cholecystectomy. In the study considering the factors which were significant in Univariate analysis, Previous hospitalization, GB thickness >4 mm and presence of Impacted stone were significant factors in predicting difficult operation in Cholecystectomy. Previous hospitalization had 5.006 times higher chances of Difficult Cholecystectomy, GB Thickness >4 mm had 3.251 times higher chances of Difficult Cholecystectomy and Impacted Stone had 3.251 times higher chances of Difficult Cholecystectomy. Conclusion:We conclude that difficult laparoscopic cholecystectomy and conversion to open Cholecystectomy can be predicted preoperatively based on number of previous attacks of cholecystitis and hospitalization, gallbladder wall thickness and impacted stone at neck of gallbladder.