Abstract

The objective of this study is to evaluate the risk factors that can predict difficult laparoscopic cholecystectomy (LC) and the possibility of conversion to open cholecystectomy (OC) in our setup. Furthermore, the study aims to suggest a scoring system that can be used preoperatively to identify high-risk patients who would benefit from preparation for LC. Such a system could prove beneficial to both the patient and the surgeon, facilitating enhanced preparation for intraoperative risk and the potential for conversion to open cholecystectomy.  The prospective study was conducted at the third surgical unit of Baghdad Teaching Hospital, Medical City, between January 2015 and January 2016. The study sample consisted of 130 patients with a history of gallstone disease. All patients were admitted to the hospital one day prior to the scheduled surgical procedure. At the time of admission, the following information was obtained from the patients and recorded in a special questionnaire form prepared for patients who were admitted for elective laparoscopic cholecystectomy (LC). Age, gender, and body mass index (BMI) were calculated as weight (in kilograms) divided by squared height (in metres). Among the 130 patients who underwent laparoscopic cholecystectomy (LC), males comprised 21 (16.2%), and females were 109 (83.8%). Regarding the history of admission for acute cholecystitis, it was noted that 44 (33.8%) Previous hospitalisation for conservative treatment of acute cholecystitis was noted in 130 patients, while 86 (66.2%) patients had no history of any admission. Of the 130 patients with cholecystolithiasis on sonography, the sonographist diagnosed 112 (86.2%) patients with GB wall thickness < 4 mm, while 18 (13.8%) patients had GB wall thickness ≥ 4 mm. A thickness of ≥4 mm was recorded as the cut-off point for defining the duration of the operation. The time of operation was recorded from the insertion of the first port until the removal of the last port. The results demonstrated that 78 patients (60%) had an operation time of <60 min, while 46 patients (35.4%) had an operation time of 60–120 min. Only six patients (4.6%) had prolonged surgery for >120 minutes. The duration of the surgical procedure for all patients ranged from 30 to 140 minutes. The application of this scoring system revealed that the majority of patients with a total score of 4 or above would experience a challenging surgical procedure, whereas those with a score below four would undergo an easier surgery. As illustrated in Table 9, there was a notable correlation between preoperative scoring and intraoperative outcomes, with a p-value of less than 0.001

Keywords

Preoperative, Anticipation, Laparoscopic Cholecystectomy, Patients, BMI