Predicting Operative Difficulties During Laparoscopic Cholecystectomy using Clinical and Radiological Criteria Based on Intraoperative Findings

Laparoscopic cholecystectomy (LC) being the gold standard treatment of symptomatic cholelithiasis preoperative prediction of the risk of conversion is an important aspect of planning laparoscopic surgery. It is important to predict difficult LC preoperatively during surgery rather than to avoid complications during surgery. This study aimed predicting operative difficulties during laparoscopic cholecystectomy using clinical and radiological criteria based on intraoperative findings. This prospective clinical study was conducted at El Zahraa University Hospital within two years duration, on one hundred fifty patients (N=150) presented to out-patients clinic suffering from gall bladder disease and scheduled for laparoscopic cholecystectomy. The results of this study showed that, the benefit of laparoscopic cholecystectomy over open surgery has been extensively accepted. However, many times it is challenging, and the surgeon has to face the difficulty that might lead to injury to adjacent structures leading to an increase in morbidity. Therefore, the preoperative estimate of a difficult LC is essential to predict the difficulty as well as for a better surgical plan. It also helps the surgeon in being better prepared to anticipate the intra operative difficulties that reached among the included patients with rate 1.3% and 21.3% respectively. This study concluded that, gender (male), past history of acute cholecystitis, gallbladder wall thickness (≥4–5 mm), fibrotic gallbladder, and adhesion at Calot’s triangle are significant predictors for difficult LC. Moreover, an awareness about reliable predictors for difficult LC would be helpful for an appropriate treatment plan and application of the resources to anticipate difficult LC.