Abstract

Laparoscopic cholecystectomy is the gold standard treatment for symptomatic cholelithiasis. However, of all Laparoscopic cholecystectomies, 1-13% requires conversion to an open surgery. Thus, for surgeons it would be helpful to establish criteria that would predict difficult laparoscopic cholecystectomy and conversion preoperatively. The objective of the study was to compare preoperative parameters with intraoperative parameters associated with difficult laparoscopic cholecystectomy. Methods: Analytical cross sectional study includes 68 patients having symptomatic cholelithiasis. All patients underwent elective LC in Department of General Surgery in tertiary care center at hingna, Nagpur. The collected data of preoperative factors include sex, age, previous attack, obesity (BMI), lower abdominal scar, palpable gallbladder, wall thickness of gall bladder, pericholecystic collection and impacted stone in Hartman’s pouch and intraoperative factors include gall bladder adhesions to bowel and adjacent structure, duct and artery clipping, omental adhesions and extraction of gall bladder. Results: In this study, previous history of attacks of cholecystitis, body mass index, prior abdominal surgical history, gall bladder wall thickness and impacted stones in Hartmann's pouch were found to be statistically significant in predicting difficult LC. Factors such as age, sex, palpable gall bladder and pericholecystic collection were not statistically significant in predicting difficult LC. Conclusions: The difficult laparoscopic cholecystectomy and conversion to open surgery can be predicted preoperatively based on number of previous attacks of cholecystitis, body mass index, prior abdominal surgical history, gall bladder wall thickness and impacted stones in Hartmann's pouch.

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