title: The analysis of 146 patients with difficult laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is very commonly performed surgical intervention. Acute or chronic cholecystitis, adhesions due to previous upper abdomen surgeries, Mirrizi's syndrome and obesity are common clinical conditions that can be associated with difficult cholecystectomy. In this study, we evaluated and scored the patients with difficult surgical exploration during laparoscopic cholecystectomy.
  
  
  METHODS
  All patients who underwent LC from 2010 to 2015 were retrospectively rewieved. According to intraoperative findings DLC cases were described and classified. Class I difficulty: Adhesion of omentum majus, transverse colon, duodenum to the fundus of the gallbladder. Class II difficulty: Adhesions in Calot's triangle and difficulty in dissection of cystic artery and cystic duct Class III difficulty: Difficulty in dissection of gallbladder bed (scleroathrophic gallbladder, hemorrhage from liver during dissection of gallbladder, chirotic liver). Class IV difficulty: Difficulty in exploration of gallbladder due to intraabdominal adhesions including technical problems.
  
  
  RESULTS
  A total of 146 patients were operated with DLC. The most common difficulty type was Class I difficulty (88 patients/60.2%). Laparoscopic cholecystectomy was converted to laparotomy in 98 patients. Operation time was found to be related with conversion to open surgery (P<0.05). Wound infection rate was also statistically higher in conversion group (P<0.05). The opertion time was found to be longest with Class II difficulty. Conversion rate to open surgery was also highest with Class II difficulty group.
  
  
  CONCLUSIONS
  Class II difficulty characterized by severe adhesions in calot's triangle is most serious problem among all DLC cases. They have longer operation time and higher conversion rate.
authors.affiliation: Department of General Surgery, Kanunı S.S. Training and Research Hospital Istanbul, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Bat
keywords: Laparoscopic cholecystectomy; analysis; difficulty