title: Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment.
abstract: BACKGROUND
  Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open for various reasons. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. But there is no clear consensus among the laparoscopic surgeons regarding the parameters predicting the difficult dissection and conversion to open cholecystectomy.
  
  
  OBJECTIVE
  To assess the clinical and radiological parameters for predicting the difficult laparoscopic cholecystectomy and its conversion.
  
  
  METHODS
  This was a prospective study conducted from October 2010 to October 2014. Total of 180 patients meeting the inclusion criteria undergoing LC were included in the study. Four parameters were assessed to predict the difficult LC. These parameters were: 1) Gallbladder wall thickness; 2) Pericholecystic fluid collection; 3) Number of attacks; 4) Total leucocyte count. The statistical analysis was done using Z-test.
  
  
  RESULTS
  Out of 180 patients included in this study 126 (70%) were easy, 44 (24.44%) were difficult and 3 (5.56%) patients required conversion to open cholecystectomy. The overall conversion rate was 5.6%. The TLC>11000, more than 2 previous attacks of cholecystitis, GB wall thickness of >3mm and Pericholecystic collection were all statistically significant for predicting the difficult LC and its conversion.
  
  
  CONCLUSIONS
  The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, WBC count, Gall bladder wall thickness and Pericholecystic collection.
authors.affiliation: Senior Resident, Department of GI & HPB Surgery, Jagjivan Ram Railway Hospital , Mumbai Central, India .
authors.forename: Ravindra
authors.initials: R
authors.lastname: Nidoni
authors.affiliation: Professor and HOD, Department of General Surgery, BLDEU's Shri. B. M. Patil Medical College , Bijapur, India .
authors.forename: Tejaswini V
authors.initials: TV
authors.lastname: Udachan
authors.affiliation: Assistant Professor, Department of General Surgery, BLDEU's Shri. B. M. Patil Medical College , Bijapur, India .
authors.forename: Prasad
authors.initials: P
authors.lastname: Sasnur
authors.affiliation: Associate Professor, Department of General Surgery, BLDEU's Shri. B. M. Patil Medical College , Bijapur, India .
authors.forename: Ramakanth
authors.initials: R
authors.lastname: Baloorkar
authors.affiliation: Assistant Professor, Department of General Surgery, BLDEU's Shri. B. M. Patil Medical College , Bijapur, India .
authors.forename: Vikram
authors.initials: V
authors.lastname: Sindgikar
authors.affiliation: Associate Professor, Department of General Surgery, BLDEU's Shri. B. M. Patil Medical College , Bijapur, India .
authors.forename: Basavaraj
authors.initials: B
authors.lastname: Narasangi
keywords: Cholecystitis; Conversion; Difficult cholecystectomy; Pericholecystic collection
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