Pre-operative predicton of difficult laparoscopic cholecystectomy

Abstract

Introduction: The study's goal was to evaluate the preoperative predictability of challenging laparoscopic cholecystectomy. Factors such as age (>50 years), BMI (≥30 kg/m²), male gender, history of acute cholecystitis, pancreatitis, prior upper abdominal surgeries, gall bladder wall thickness (>3 mm), the presence of pericholecystic fluid, and a white blood cell count (>10,000 cells/mm³) were considered as potential predictors for the need to convert laparoscopic cholecystectomy to open cholecystectomy. This conversion is necessary in 3 to 10% of laparoscopic cholecystectomy cases performed worldwide due to various factors. Materials and Methods: The present study was a prospective study of patients who underwent laparoscopic cholecystectomy during 2 years study period. Patients who met the inclusion criteria are included in the study. Results: Significant predictive factors for difficult laparoscopic cholecystectomy were gall bladder wall thickness more than 3mm, wbc count more than 10000 cells per cubic milli metre and presence of pericholecystic fluid collection. Conclusion: Pre-operative findings of gall bladder wall thickness more than 3mm, wbc count more than or equal to 10000 cells per cubic milli metre and presence of pericholecystic fluid collection can help in the prediction of difficult laparoscopic cholecystectomy. Other factors like old age more than 50 years, male gender, past history of acute cholecystitis and acute pancreatitis and history of upper abdominal surgeries and BMI>30 were not helpful in predicting difficult laparoscopic cholecystectomy preoperatively.