Preoperative prediction of difficult lap chole: a scoring method
Jaskiran S Randhawa1, Aswini K Pujahari
1Department of Surgery, Command Hospital (IAF), Bangalore, 560 007 India.
Background:
Laparoscopic cholecystectomy (LC) has become the procedure of choice for management of symptomatic gallstone disease. At times it is easy and can be done quickly. Occasionally it is difficult and takes longer time. But there is no scoring system available to predict the degree of difficulty of LC preoperatively.
Aim:
To develop a scoring method to predict difficult LC preoperatively.
Materials And Methods:
There were 228 cases in 2 years, operated by a single experienced surgeon. There are total 15 score from history, clinical, sonological findings. Score up to 5 predicted easy, 6-10 difficult and >10 are very difficult.
Results:
Prediction came true in 88.8% for easy and 92% difficult cases there were no cases with score above 10. The factors like BMI > 27.5 (p < 0.010), previous hospitalization (p < 0.001), palpable GB (p < 0.01) US-Thick-walled GB (p < 0.038) are found of statistical significance in predicting difficult LC.
Conclusion:
The proposed scoring system is reliable with a sensitivity and specificity of 75.00% and 90.24%, respectively.