Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters

Abstract EN

Background : Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic cholelithiasis.

It has revolutionized minimally invasive procedures.

Laparoscopic cholecystectomy may be rendered difficult by various problems encountered during surgery.

The aim of this study was to predict difficulty of LC and possibility of conversion to open cholecystectomy (OC) before surgery using the clinical and ultrasonographic criteria.

Methods : This study was carried out on 40 patients with symptomatic cholelithiasis, normal liver function tests and non-dilated bile ducts.

Patients with acute cholecystitis, evidence of concomitant choledocholithiasis and history of upper abdominal surgery were excluded.

All patients underwent abdominal ultrasound examination prior to laparoscopic cholecystectomy.

Results : LC was successfully accomplished in 37 patients (92.5%) with a mean operative time of 51 ± 10.19 minutes.

The Access difficulties occurred in 5 patients (12.5%).

Minimal bleeding occurred in 4 patients (%10) from the liver bed during gall bladder bed dissection.

Gall bladder bed dissection was difficult in 4 patients (10%).

Gall bladder perforation occurred in 8 patients (20%) while stone spillage occurred in 5 patients (12.5%) and were all retrieved.

Extraction of the excised gall bladder was difficult in 4 patients (10%).

Conversion to laparotomy occurred in 3 patients (7.5%).

The preoperative parameters that significantly predicted difficult LC were based on the presence of local signs of cholecystitis in addition to the ultrasound criteria of liver fibrosis, large stones and thick wall gall bladder exceeding 3mm.

Conclusions : Clinical and ultrasonographic findings may help predict a difficult LC.

This information may be useful to both the patient and the treating surgeon.