Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters.
BACKGROUND
Pre-operative prediction of a difficult laparoscopic cholecystectomy (LC) can help the patient as well as the surgeon prepare better for the intra-operative risk and the risk of conversion to open cholecystectomy.


METHODS
In 105 eligible patients who underwent LC during May 2001 to January 2003, patient characteristics, clinical history, laboratory data, ultrasonography results and intra-operative details were prospectively analyzed to determine predictors of difficult LC.


RESULTS
Of 105 patients, 12 (11.4%) required conversion to open cholecystectomy. Significant predictors of conversion were body mass index> 30 Kg/m2, male gender, past history of acute cholecystitis or acute pancreatitis, past history of upper abdominal surgery, and gall bladder wall thickness exceeding 3 mm.


CONCLUSIONS
Clinical and ultrasonograpic factors can help predict difficult LC and likelihood of conversion of LC to open surgery.
Nachnani
Jagdish
J
Department of Surgical Gastroenterology, Seth G S Medical College and K E M Hospital, Mumbai-400 012, India.
Supe
Avinash
A
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D002769:Cholelithiasis / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000601:surgery; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods