DEVELOPMENT AND VALIDATION OF A PREOPERATIVE SCORING SYSTEM TO PREDICT THE DIFFICULTY OF LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE OBSERVATIONAL STUDY
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Keywords
Laparoscopic cholecystectomy, preoperative predictive scoring, gallstones, surgical difficulty.
Abstract
Background: Laparoscopic cholecystectomy is considered the gold standard treatment for any gall bladder pathology. Laparoscopic cholecystectomy has grown challenging at times. When there are extensive adhesions and bile/stone spillage, it takes longer and sometimes requires an open cholecystectomy. Anticipating the level of difficulty before surgery is a challenging task. By determining the variables that may indicate difficulty during a laparoscopic cholecystectomy, problems can be avoided.
Aim: To develop and validate a preoperative scoring system to predict the difficulty of laparoscopic cholecystectomy.
Methods: The study was conducted from August 2022 to June 2024, involving 115 patients undergoing LC. The following parameters were assessed to predict the difficult LC, demographic data, BMI, Number of attacks of pain, past history of acute cholecystitis, Tenderness in the right hypochondrium, CBC, LFT, U.S.G. abdomen (Gallbladder (normal/contracted/distended), Gb wall thickness, No. Of stones, Pericholecystic fluid collection. The scoring system used categorised scores into easy (0-5), difficult (6-10), and very difficult (11-15). The scores were then correlated with intraoperative findings. Data was analysed using SPSS (version 20) software.
Results: Age (p-value-0.047), BMI(p-value-<0.001), previous history of acute cholecystitis (p-value-0.024), total leucocyte count(p-value-<0.001), gallbladder wall thickness (p-value-<0.001) and a number of stones (p-value-0.014) is a significant risk factor in predicting difficulty. The prediction was true in 82.60 % of easy cases and 78.26% of difficult cases. The sensitivity of the scoring system is 100%, and specificity is 79.3%. The positive predictive value is 82.6%, and the negative predictive value is 100%.
Conclusion: The preoperative scoring system is an effective and reliable tool for predicting the difficulty of laparoscopic cholecystectomy. This can improve surgical planning, minimize complications, and potentially reduce the need for conversion to open cholecystectomy.
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Dr. Priyatma Kumari
Junior resident 3rd year, Department of General Surgery, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India.
Dr. Girish Kullolli
Professor, Department of General Surgery, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India.
Dr Tejaswini Vallabha
Professor, Department of General Surgery, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India.
Dr. Shruti Sheelin
Assistant professor, Department of General Surgery, Shri B.M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India.