Preoperative predictive risk factors of difficult laparoscopic cholecystectomy

Abstract

Background Laparoscopic cholecystectomy (LC) is the preferred approach for treatment of gallbladder (GB) diseases. LC is relatively an easy procedure and can be done quickly, but in some cases, LC may be difficult, takes longer time, and needs special instrument and a well-trained surgeon. Moreover, in specific situations, conversion from laparoscopic to open approach is still required. However, identification of those cases at high risk for conversion is not easy. Aim This article was conducted to detect the preoperative parameters that make LC difficult and elevate the rate of conversion from LC to open approach. Patients and methods During the period from September 2019 to December 2020, 100 LC cases were performed in the Surgical Department, Al Azhar University Hospitals, Assiut. Examined preoperative parameters were age, sex, BMI, previous attacks of acute cholecystitis, obstructive jaundice with or without endoscopic retrograde cholangiopancreatography, previous abdominal surgery, the thickness of wall of GB, size and number of GB calculi, abnormal liver functions, and leukocytosis, which were used for determination of those variables that predict conversion of LC. The term ‘difficult’ cholecystectomy is mainly based on operative findings and is highly dependent on the skills of surgeon in handling a thickened GB wall (difficulties in grasping and retraction of the GB, limited identification of the anatomy, and difficulty in dissection), adhesions, and presence of common bile duct stones or Mirizzi’s syndrome. Results Difficult LC was found in 28 (28%) patients. A total of four (4%) patients had been converted to open cholecystectomy. Parameters like BMI more than 30, empyema of GB, thick-walled GB, large size stones, multiple GB calculi, recurrent acute attack, and previous endoscopic retrograde cholangiopancreatography are found of statistical significance and can be used as criteria for predicting difficult LC. Conclusion Many preoperative parameters can expect the possibilities of conversion from LC to open technique and the drawbacks throughout LC.