Assessment of risk factors for difficult surgery in laparoscopic cholecystectomy: An observational study

Abstract

Background: Laparoscopic cholecystectomy has become the gold standard for the treatment of gallstones. The objective of our study was to identify the preoperative predictors of conversion of laparoscopic cholecystectomy into open cholecystectomy. Methods & Subjects: We carried out a cross‑sectional study of 110 patients admitted to the Department of GI and Minimal Access Surgery, Fortis Hospital, Kolkata, West Bengal, India, from January 2019 to March 2019. All patients undergoing laparoscopic cholecystectomy were included in the study. Informed consent was obtained from all the participants. A structured questionnaire was used to collect the demographic data including age, sex, body mass index (BMI), comorbidities, and previous history of gallstones along with preoperative and operative findings from each patient. Results: A total of 110 patients were included in this study; the majority of them were females [74 (67.27%)]. In our study, the mean age was 46.72 years (SD: ±17.68 years). Majority of the patients 79 (71.82%) in the present study who was undergone through cholecystectomy, age less than 50 years. Regarding ultrasonography findings, 86 (78.18%) patients had multiple stone, whereas 23 (20.91%) patients had solitary stone. About 17 (15.45%) had impacted stone. Near about 29 (26.36%) patients had wall thickness greater than or equal to 4 mm. On preoperative evaluation, the number of cases predicted to be difficult/very difficult were 45 (40.91%) patients, and 21 (19.1%) of them were difficult/very difficult on surgery, whereas 24 (21.82%) patients turned out to be easy on surgery. Conclusion: The cases predicted to be easy on preoperative evaluation were 65 (59.09%) patients, of which 59 (53.64%) patients were actually easy, whereas 6 (5.45%) patients turned out to be difficult/very difficult on surgery. The rate of conversion of laparoscopic cholecystectomy to open cholecystectomy was found to be in nil patients. The decision to convert to open cholecystectomy is usually taken after a considerable time has been spent on trying to successfully perform the laparoscopic procedure. A significant delay in this decision can result in increased morbidity and mortality. Preoperative risk factors can help to predict difficult gallbladder and conversion to open cholecystectomy