Difficult Laparoscopic Cholecystectomy Predictors and its Significance: Our Experience

Area of Science:

• General Surgery
• Gastroenterology

Background:

• Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstone disease.
• Difficulties in LC arise from inflamed gallbladder, adhesions, fistulas, and contracted gallbladders, potentially leading to conversion or complications.
• Preoperative assessment is vital for managing challenging LC cases.

Purpose of the Study:

• To evaluate preoperative factors for predicting difficult laparoscopic cholecystectomy (LC).
• To assess the validity of the Randhawa and Pujahari scoring system in a hospital setting for predicting difficult LC.

Main Methods:

• A 2-year observational study in the Department of General Surgery.
• Inclusion of all patients admitted for elective LC for cholelithiasis.
• Analysis of preoperative factors to identify predictors of difficult LC.

Main Results:

• Factors predicting difficult LC include age ≥50 years, history of acute cholecystitis, BMI ≥25 kg/m², abdominal scar, palpable gallbladder, GB wall thickness ≥4 mm, pericholecystic collection, and impacted stone.
• Endoscopic retrograde cholangiopancreatography and pancreatitis are independent risk factors for difficult LC.
• The Randhawa and Pujahari scoring system showed effectiveness but had limitations.

Conclusions:

• The scoring system should be a protocol for predicting difficult LC preoperatively.
• Utilizing the scoring system can guide surgical approach, patient counseling, and reduce complications and costs.
• The Randhawa and Pujahari scoring system is effective but requires refinement.