Background: Laparoscopic cholecystectomy is widely accepted as the gold standard surgical treatment for gall stone disease. However, owing to technical difficulties during surgery, complications or conversion to open surgery may be needed leading to undesired trouble for both surgeon and patient.
Objectives: To evaluate predictors of a difficult laparoscopic cholecystectomy by pre-operative assessment of the clinical, laboratory, ultrasonographic (USG), and computed tomographic (CT) variables.
Patients and methods: This was a retrospective observational study done in patients undergoing laparoscopic cholecystectomy during a period of 1 year at a tertiary care medical institute in Northern India which comprised 32 patients of difficult laparoscopic cholecystectomy (surgery duration of more than 60 minutes or any major complications) and a control group of 32 patients undergoing easy laparoscopic cholecystectomy during the same time interval. Multiple clinical, laboratory & radiological parameters were assessed in cases and controls by analysis of hospital data and imaging records.
Results: Male gender, fever with raised inflammatory markers, impacted calculus with palpable gallbladder (GB), and signs of inflammation on USG and CT including GB wall thickness and pericholecystic fluid/stranding were major predictors of a tough laparoscopic surgery.
Conclusion: A well-defined clinical, laboratory & radiological assessment pre-operatively has the potential to prevent an arduous laparoscopic experience for both surgeon and the patient & provide a directive to take a better informed and planned surgical approach. Inflammatory markers and previous attacks are the strongest predictors of an upcoming difficulty. Both USG and CT have independent roles in paving the path for pre-operative diagnosis for the surgeon.