title: Validation of a scoring system to predict difficult laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures being performed by general surgeons all over the world. Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery. The purpose of our prospective study was to analyze various risk factors and to predict difficulty and degree of difficulty preoperatively by the use of a scoring system.
  
  
  METHODS
  This prospective study was conducted in the department of surgery, Lady Hardinge Medical College and associated Dr Ram Manohar Lohia Hospital, Delhi, India. The parameters considered in the preoperative scoring method were old age, male sex, history of hospitalization, obesity, previous abdominal surgery scar, palpable gall bladder, wall thickness of gall bladder, pericholecystic collection and impacted stone. A total of 210 patients were included in the study.
  
  
  RESULTS
  We found that history of hospitalization, palpable gall bladder, impacted stone and gall bladder wall thickness were statistically significant factors for prediction of difficult laparoscopic cholecystectomy. Sensitivity and specificity of this preoperative scoring method were found to be 95.74% and 73.68% respectively. Positive predictive values of this scoring method were 90% and 88% for easy and difficult cases respectively. Area under ROC curve was 0.86. Conversion rate from laparoscopic to open cholecystectomy was found to be 4.28%.
  
  
  CONCLUSIONS
  With the help of accurate prediction, high risk patient may be informed before hand regarding the probability of conversion and hence they may have a chance to make arrangements accordingly. On the other hand, surgeons also may have to schedule the time and team for the operation appropriately. Surgeons can also be aware about the possible complications that may arise in high risk patients.
authors.affiliation: Department of Surgery, University College of Medical Sciences, Delhi, India. Electronic address: nikhil_ms26@yahoo.co.in.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Gupta
authors.forename: Gyan
authors.initials: G
authors.lastname: Ranjan
authors.forename: M P
authors.initials: MP
authors.lastname: Arora
authors.forename: Binita
authors.initials: B
authors.lastname: Goswami
authors.forename: Poras
authors.initials: P
authors.lastname: Chaudhary
authors.forename: Arun
authors.initials: A
authors.lastname: Kapur
authors.forename: Rajeev
authors.initials: R
authors.lastname: Kumar
authors.forename: Tirlok
authors.initials: T
authors.lastname: Chand
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Difficult; Laparoscopic cholecystectomy; Prediction; Scoring system