Assessment of Operative Predictors for Difficulty in Laproscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy from the day of its introduction has aimed at improving the results of traditional surgical treatment and is regarded as gold standard treatment in cholecystitis. The study was aimed to assess various operative predictors for difficult laproscopic cholecystectomy. Material and methods: The present prospective study was conducted over 108 patients with diagnosis of cholelithiasis confirmed by abdominal ultrasonography (USG). Surgical procedure was categorized postoperatively into easy, difficult and very difficult surgical procedure on the basis of time taken in minutes, bile/stone spillage, injury to duct and conversion to open cholecystectomy. Data so obtained was analyzed using SPSS-16 data analysis software. Chi square test was used for statistical analysis with p<005 as significant value. Results: The present study found that obesity, co-morbid diseases, previous history of acute cholecystitis or pancreatitis, delayed surgery after 72 hour of gall bladder inflammation, increased thickness of gallbladder, fibrosis of liver parenchyma, multiple stones, size of calculi more than 1 cm are significant factors that result in difficult and very difficult surgical procedures. Conversion to open cholecystectomy was seen in 19 (17%) patients. Conclusion: Patient characteristics indicates a type of laparoscopic cholecystectomy procedure i.e. easy, difficult or very difficult. Pre-operative prediction of a difficult laproscopic cholecystectomy can help the surgeon to better prepare for risk factors or intra-operative complications and can help to predict the risk of conversion to open cholecystectomy.