IS THERE STILL A DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY? — AN EXPLORATIVE AND DESCRIPTIVE STUDY TO IDENTIFY RISK FACTORS AND TO ESTABLISH A SCORING SYSTEM FOR DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY.

Abstract

Background: Gallstone disease is among the most common gastrointestinal illness requiring hospitalization. Laparoscopic cholecystectomy is now the preferred approach to its treatment. When performing laparoscopic cholecystectomy, the surgeon should have the low threshold for open conversion in case of difculty. The aim of the study was Pre-operative prediction of difcult laparoscopic cholecystectomy using clinical, ultrasonographic and intraoperative parameters. Methods:This study was done on 200 patients presenting with symptomatic cholelithiasis who underwent laparoscopic cholecystectomy. A prospective analysis of parameters including the patient demographics, laboratory values, radiologic data and intraoperative parameters was performed. Results: The factors which were considered a difculty parameter were males, age>60years, preoperative ERCP, rised amylase, sonographic features of contracted or distended gallbladder and pericholecystic collection. Intraoperative parameters were adhesions around gallbladder, contracted or distended gallbladder inamed gallbladder. Conclusions: The above mentioned factors must be adequately studied and the surgeon and the patient should be prepared for difcult laparoscopic cholecystectomy.