Preoperative indicators of technically difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

• Published in: The Egyptian journal of surgery : official organ of the Egyptian Society of Surgeons = Majallat al-jirāhah al-Misrīyah Vol. 38; no. 3; pp. 542 - 547
• Main Authors: Hamza, Hosam, Radwan, Moustafa, Daqqaq, Tareef
• Format: Journal Article
• Language: English
• Published: Wolters Kluwer India Pvt. Ltd 01.07.2019; Medknow Publications and Media Pvt. Ltd
• Subjects: Diagnostic imaging; Gallstones; Laparoscopy; Medical research; Surgery; Ultrasound imaging; prediction; technical difficulty; laparoscopic cholecystectomy
• ISSN: 1110-1121; 1687-7624
• DOI: 10.4103/ejs.ejs_64_19

Background Laparoscopic cholecystectomy (LC) has rapidly become the operation of choice for routine gallbladder (GB) removal. The purpose of this study is to provide preoperative indicators of a technically difficult LC based on various preoperative clinical and ultrasonographic predictors. Patients and methods This study was conducted in the General Surgery Department, Ohud General Hospital, Al Madinah Al Munawarah, Saudi Arabia, for 280 patients with diagnosis of gallstones confirmed by abdominal ultrasonography and subjected to LC. The technical difficulty of the surgical procedure was assessed postoperatively (either easy, difficult, or very difficult) based on operative time (min), spillage of bile and/or stones, bile duct injury, and the need for conversion to open surgery. Results The present study found that old age; male sex; previous history of acute cholecystitis or acute pancreatitis; history of previous abdominal surgery; urgent surgery after 72 h of the onset of symptoms in acute cholecystitis; morbid obesity; ultrasonographic findings including increased of GB wall thickness, impacted stones, sonographic Murphy's sign, and pericholecystic fluid collection; and palpable GB increase the technical difficulty of LC. Conversion to open cholecystectomy was seen in only one patient. Conclusion Clinical and radiological patient characteristics are good preoperative predictors for the technical difficulty of LC and can help the surgeon to anticipate the risk for intraoperative complications and the possible need for conversion to open cholecystectomy.