Assessment of factors predicting difficult laparoscopic cholecystectomy preoperatively

Authors

  • Ahmad Eid Tishreen University
  • Samir Kanaan Tishreen University
  • Ali Alloush Tishreen University

Abstract

Background: Laparoscopic cholecystectomy is considered the most commonly performed operation and as the standard treatment for cholelithiasis. Difficult cholecystectomy is associated with serious complications and high rate of surgical conversion.     

Aim:  The purpose of this study was to investigate the  predictive factors for difficult laparoscopic cholecystectomy.

Materials and Methods: This was an analytical study  (cross sectional) involving 156 patients who underwent laparoscopic cholecystectomy. They were selected from Department of General surgery, Tishreen University Hospital, Lattakia, during the period 2022-2023.

Results: Out of 156 patients, 46 were male and 110 were female. Mean age of the patients was 62.13±7.4  years with presence of diabetes mellitus(DM) in 14 cases(9%). According to Randhawa score, cholecystectomy was easy in 138 cases(88.5%) and difficult in 18 cases(11.5%) with detecting operative difficulty in laparoscopic cholecystectomy in 111 cases(71.2%). Cholecystectomy was more difficult in patients older than 50 years(p:0.04) and with increasing body mass index(BMI)(p:0.03). There were no significant differences regarding of difficult cholecystectomy according to gender(p:0.9), precence of DM(p:0.2), previous history of ERCP(p:0.3), hospitalization for cholecystitis (p:0.07), prior abdominal surgery(p:0.2), levels of CRP(p:0.8), echographic findings including thickening of the gallbladder wall(p:0.08), pericholecystic fluid(p:0.1), impacted stone in gallbladder neck(p:0.1), and Randhawa score(p:0.07). Accuracy, sensitivity, specificity, and positive predictive value of Randhawa score were37.82%, 14.41%,95.55%, and 88.88% respectively. In addition to, cholecystectomy was easy in 61 cases(39.1%) and difficult in 95 cases(60.9%) according to modified Randhawa score depending on the most statistically significant factors with accuracy, sensitivity, specificity, and positive predictive value: 69.23%,71.17%, 64.44%, and 83.15% respectively.              

Conclusion: The current study demonstrated the importance of use preoperative scale to predict the difficulty of surgery in patients who are planning laparoscopic cholecystectomy , inform patient with adequate preoperative planning and request support if necessary.

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Published

2024-06-06

How to Cite

1.
عيد ا, سمير كنعان, علي علّوش. Assessment of factors predicting difficult laparoscopic cholecystectomy preoperatively. Tuj-hlth [Internet]. 2024Jun.6 [cited 2024Jun.30];46(2):191-203. Available from: https://journal.tishreen.edu.sy/index.php/hlthscnc/article/view/16848

Issue

Vol. 46 No. 2 (2024): Tishreen University Journal for Research and Scientific Studies - Health Sciences Series

Section

Master student researches

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