PREDICTORS OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY-A CLINICAL STUDY

Background: Gallstones are one of the common surgical problems throughout the world. Laparoscopic cholecystectomy has become the gold standard in the treatment of cholelithiasis. However in 2% to 15% of patients laparoscopic cholecystectomy are converted to open cholecystectomy because of technical difficulty or intraoperative complications. Objective: To evaluate clinical and ultrasonographic parameters as predictors of difficult laparoscopic cholecystectomy and to correlate these predictors with operative findings and surgical outcomes. Methods: This hospital based cross-sectional study was conducted from June 2016 to December 2016 in B.P.K.I.H.S., Dharan, Nepal. All cases (n=63) with cholelithiasis admitted for Laparoscopic cholecystectomy were included. Following data were recorded in the performa for study: Age, sex, obesity of the patients, previous abdominal surgery and past history of acute attack of cholecystitis, Ultrasonographical findings of gall bladder, thickened gall bladder wall and number of stones and intraoperative cause for the conversion. Results: Difficulty was seen in all age groups, but conversion rate was higher in above 50 years. , BMI greater than 30 kg/m2 (overweight patient) had higher chances of difficult laparoscopic cholecystectomy and conversion was also more in this group. Thickened GB wall greater than 3 mm, multiple stones and stone impacted in Hartmann’s pouch were factors responsible for difficult LC.Perforation of gall bladder during surgery with bile leak and or dropped stone leads to difficult LC. Abstract word count: 220