A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy.
BACKGROUND
Laparoscopic cholecystectomy (LC) is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted.


OBJECTIVE
To develop a scoring method that predicts difficult laparoscopic cholecystectomy.


METHODS
Bidirectional prospective study in a medical college setup.


METHODS
Following approval from the institutional ethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed proforma stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered.


METHODS
Chi Square test and Receiver Operater Curve (ROC) analysis.


RESULTS
Total 323 patients were included. On analysis, elderly patients, males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP), abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG) were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956. A score above 9 was considered difficult with sensitivity of 85% and specificity of 97.8%.


CONCLUSIONS
This study demonstrates that a scoring system predicting the difficulty in LC is feasible. There is scope for further refinement to make the same less cumbersome and easier to handle. Further studies are warranted in this direction.
Department of Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka - 575 001, India.
Mittalgodu Anantha Krishna Murthy
MA
Vivek
Department of Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka - 575 001, India.
Alfred Joseph
AJ
Augustine
Department of Surgery, Kasturba Medical College, Manipal University, Mangalore, Karnataka - 575 001, India.
Ranjith
R
Rao
Cholecystectomy; difficult cholecystectomy; laparoscopic cholecystectomy; laparoscopy; minimal access surgery