Keywords : open cholecystectomy


Preoperative Prediction of Difficult Laparoscopic Cholecystectomy by Clinical Assessment and Ultrasonagraphy

Mohamed Salih Younis

Iraqi Postgraduate Medical Journal, 2013, Volume 12, Issue 2, Pages 196-201

ABSTRACT:
BACKGROUND:
Laparoscopic cholecystectomy(LC) has now replaced open cholecystectomy(OC) for the treatment of
gallbladder diseases. However, LC may be rendered difficult by various problems encountered during
surgery, such as difficulties in accessing the peritoneal cavity, dissecting the Calot’s triangle and gall
bladder, or extracting the excised gall bladder.
OBJECTIVE:
Of this prospective study: is to determine whether preoperative clinical parameter and Ultrasonagraphy
can predict difficult LC.
PATIENT AND METHODS:
100 patients underwent LC in Al-Jamhuri Teaching Hospital, all had gallstone disease. Prospective
analyses of different preoperative clinical and ultrasonic parameters contributing to difficult LC were
performed. These included: age, gender, BMI (Body Mass Index), previous upper abdominal surgery,
previous attack of acute cholecystitis , gall bladders size , gall stones size and numbers. The outcomes
included the following operative parameters: access to peritoneal cavity, adhesion and difficult
dissection, bleeding during surgery, bile leak, and conversion to OC.
RESULTS:
Of 100 patients with LC 41 patients (41%) developed difficulties during operation .Factors contributed
to difficult LC were male sex, previous upper abdominal surgery ,previous attack of acute cholecystitis
, BMI more than 35 and gall stones that were more than (1 cm) in diameters . The most common type
of difficulties was intraoperative bile leak (14%) and the least frequent difficulty was conversion to OC
(1%).
CONCLUSION:
Clinical and ultrasonographic findings can help to predict difficult LC .This information may be useful
to both the patients and surgeons in being better prepared for the intra-operative risk including
conversion to OC