ISSN 0975-3583
 

Journal of Cardiovascular Disease Research



    Prediction Score for Difficult Laparoscopic Cholecystectomy – Feasible?


    Vinodh D, Arun Prasath S V, Abraham Benjamin Muthunayagam, Chitra R, Rajesh Kumar S
    JCDR. 2023: 818-823

    Abstract

    Laparoscopic cholecystectomy has received nearly universal acceptance and is currently considered the criterion standard for the treatment of symptomatic cholelithiasis. It is also the platform of training for surgeons. Problems like difficulty in allotment of the cases for training surgeons and junior residents, risks of possible difficulties intra op that can be encountered that needs to be explained to patient and attenders beforehand and failure of daycare surgery, can be lessened by prediction scores by helping to plan in advance. The aim of this study is to validate the Randhawa and Pujahari prediction scoring system for difficult laparoscopic cholecystectomy. The Primary objective is to estimate the sensitivity and specificity of this prediction score for Difficult laparoscopic cholecystectomy. Material and Methods: This is a retrospective cross-sectional study, conducted from 1st jan 2012 till 1st june 2018 in our institution. All patients undergoing laparoscopic cholecystectomy from 15 to 90 years of age, done by a single surgeon were included. Emergency surgeries, and those with gallbladder malignancies were excluded. 112 patients were selected based on universal sampling. The Randhawa and Pujahari prediction score of 5 and less denoted easy laparoscopic cholecystectomy. A score of 6 till 10 was difficult, and a score of 11 till 15 was very difficult respectively. Results: The original randhawa and pujahari study predicted sensitivity and specificity of 75.00% and 90.24%, respectively. The sample size in that study however was only 30. As per this study, the positive predictive value and specificity is highest in very difficult scores and the least in easy scores. The sensitivity and negative predictive value is highest in easy and least in very difficult. The overall accuracy is only 26.8%. Conclusion: While the predictive scores are useful to estimate to an extent the difficulty of the operative procedure pre operatively in a lot of cases, in our studies as well as other similar studies with sufficient sample size the test characteristics do vary in sensitivity and specificity in each study. Hence these predictive scores can be used to help anticipate difficulties but never determine the outcome with adequate certainty.

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    Volume & Issue

    Volume 14 Issue 4

    Keywords