PREDICTING THE RISK FACTOR FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: AN OBSERVATIONAL STUDY

Abstract

Background: Laparoscopic Cholecystectomy (LC) has become the gold standard in the treatment of symptomatic gallstones and it is the most frequent operation now-a-days for gallbladder stones. At times laparoscopy becomes difcult and may need conversion to open cholecystectomy. The prediction of a difcult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Aim: To study the factors determining the preoperative predictability of difcult LC based on the patient's history, physical examination and abdominal ultrasonography. Methods: 359 patients diagnosed cholelithiasis, admitted to general surgery department, KPC MCH, Kolkata-32, West Bengal. All of them underwent elective LC, and were operated by experienced laparoscopic surgeons between July 2022 and November 2023. Study design: Observational study. Results: In our study out of 359 cases 221 are male and 138 are female, male are more predominant than females (61% vs 38%). Among 359 patients 76 (21%) patients were found for difcult cholecystectomy. On multivariate logistic regression revealed that male gender, older age, H/O acute attacks, positive Murphy´s sign, past H/O acute cholecystitis requiring hospitalisation, recent H/O jaundice, past H/O co-morbidities, H/O ERCP for choledocholithiasis, H/O gall stone pancreatitis, increased gall bladder wall thickness, peri-cholecystic oedema/ collection, brotic gall bladder, intra-operative ndings of dense adhesion at calot´s triangle were independent predictors of difcult LC. Conclusion: Pre operative prediction of possible difculties may help a surgeon in choosing the appropriate approach suitable for a particular patient. Patients can pre-op be informed about possible risk of conversion to open cholecystectomy