Preoperative predictors of challenging laparoscopic cholecystectomy.

Abstract

Objective: To assess the predictability (probability) of the preoperative score in identifying difficult cases and to uncover preoperative characteristics that indicate difficult laparoscopic cholecystectomy. Study Design: Prospective Interventional study. Setting: Department of General Surgery, Sahara Medical College Narowal. Period: May 2023 and April 2024. Methods: One hundred patients whose cholecystectomy procedures were categorized as easy, tough or very difficult based on two factors: intraoperative results and preoperative assessment system were included. Results: Preoperative difficulty prediction score and intraoperative data were significantly correlated (k=0.858, P<0.001). Hospitalization (P<0.001), prior supraumbilical surgeries (P=0.004), prior acute cholecystitis (P<0.001), prior jaundice (P=0.049), prior endoscopic biliary clearance (P=0.022), increased gallbladder wall thickness (P=0.001), and pericholecystic fluid collection (P=0.014). In six cases (6%), conversion to the open method was required. Procedure difficulty was not substantially affected by age, sex, BMI, or impacted stone (P>0.05). Conclusion: Multiple preoperative characteristics have been linked to increased difficulty during laparoscopic cholecystectomy. Proper identification of these criteria and their incorporation into a scoring system would be extremely beneficial in determining challenging cases during the preoperative stage.