Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

Abstract

Background: Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times, it is difficult and takes longer time or has to be converted to an open procedure. This study is undertaken to determine the predictive factors for difficult LC.

Aim: The aim was to evaluate a scoring method to predict difficult LC preoperatively.

Materials and methods: There were 30 cases operated by a single experienced surgeon. There are total 15 score from history, clinical and sonological findings. Score up to 5 predicted easy, 6-10 difficult and >10 are very difficult.

Results: Prediction came true in 76.4% for easy and 100% difficult cases; there were no cases with a score above 10. The factors like previous history of hospitalization (P - 0.004), clinically palpable gallbladder (GB) (P - 0.009), impacted GB stone (P - 0.001), pericholecystic collection (P - 0.04), and abdominal scar due to previous abdominal surgery (P - 0.009) were found statistically significant in predicting difficult LC.

Conclusion: The proposed scoring system is reliable with a sensitivity of 76.47% and specificity of 100%.

Keywords: Difficult; laparoscopic cholecystectomy; prediction; scoring.

Graph 1

Receiver operating characteristic curve and its area under curve for predicting the operative outcome based on preoperative scores