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ORIGINAL ARTICLE
Year : 2020  |  Volume : 39  |  Issue : 3  |  Page : 515-522

Predicting the risk factors of difficult laparoscopic cholecystectomy step by step


1 Department of HBP Surgery and Liver Transplant, Menoufia University, Menoufia, Egypt
2 Department of Radiology, National Liver Institute, Menoufia University, Menoufia, Egypt

Correspondence Address:
MD Amr Mostafa Aziz
Department of Surgery, National Liver Institute, Menoufia University, Shebin El-koom, Menoufia 32511
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejs.ejs_8_20

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Background Laparoscopic cholecystectomy (LC) has become the gold standard in the treatment of symptomatic gallstones. It has replaced open cholecystectomy as the therapeutic modality in the treatment of cholelithiasis. Aim The aim of the study is to determine the predictive factors for difficult LC step by step using clinical and ultrasonography parameters. Patients and methods This is a prospective study conducted on 75 patients suffering from chronic calculous cholecystitis and planned for LC at the National Liver Institute, Menoufia University . All patients were compared according to demographic data, clinical data, laboratory profile, abdominal ultrasound result, and operation data. Results Difficult gallbladder (GB) bed dissection was found significantly related to patients with a history of acute cholecystitis, positive Murphy’s sign, history of endoscopic retrograde cholangiopancreatography (ERCP) and GB wall thickness more than 3 mm during inspection. Distended GB and dense adhesions were found statistically significant in increasing the risk of bile and stone spillage during operation. Difficulty of extraction of GB was found in patients with a history of ERCP, distended GB and GB wall thickness more than 3 mm. Risk of conversion to open was found significantly related to patients with a history of biliary pancreatitis and patients with a history of ERCP. Operative time was found prolonged in cases with a history of biliary pancreatitis, history of ERCP, distended GB, multiple stones, and dense adhesions encountered during the first 5 min inspection. Conclusion BMI, history of acute attacks, positive Murphy’s sign, history of ERCP, history of biliary pancreatitis, GB wall thickness more than 3 mm, multiple GB stones, and dense adhesion does pose difficulty in various steps during LC. So, preoperative prediction of possible difficulties may help a surgeon in choosing the approach (open/laparoscopic) most suitable for a particular patient, counseling the patient about it.


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