A CROSS SECTIONAL STUDY TO DETERMINE THE PREDICTIVE FACTORS OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

Objective To determine the clinical and radiological predictive factors for difcult laparoscopic cholecystectomy Methods A prospective study was done among 50 patients admitted to Akash Institute of Medical Sciences and Research Centre during the period of May 2022 to May 2023. The patients who presented with upper abdominal pain, vomiting or dyspepsia are studied in detail clinically and investigations were done. All patients are subjected to ultrasonographic evaluation. The patients conrmed by USG examination were evaluated with following factors: age, sex, BMI (>/<30), h/o previous hospitalization, h/o previous abdominal surgeries, h/o acute cholecystitis / pancreatitis. Sonographic ndings: GB wall thickness (>/< 3 mm), pericholecystic collection, number (solitary versus multiple) and liver parenchyma (Normal, fatty inltration, liver brosis) were noted. Following evaluation the patients were subjected to laparoscopic cholecystectomy and the following operative parameters like access to peritoneal cavity (easy/difcult), bleeding during surgery (normal/abnormal), gall bladder bed dissection (easy/difcult), injury to duct/artery, extraction of gall bladder (easy/difcult), or conversion to open surgery were noted. Analyses of pre operative risk factors, their relation to the dependent factors are performed using t-test, chi squared test and signicance (p value < 0.05) is demonstrated. Results were computed using relevant software (SPSS). Results The highest incidence of cholelithiasis was among age group of 4th decade, and more among females. Ultrasonography detected gall bladder stones in all the patients, wall thickening in 16 (32%), pericholecystic collection in 11(22%), and liver brosis in 10 (20%). Laparoscopic cholecystectomy was successfully done in 46 patents. The access to peritoneal cavity was difcult in 13(26%), gall bladder bed dissection was difcult in 10 (20%), abnormal bleeding occurred in 12 (24%) patients, difculty in gall bladder contraction in 13(26%) patients. Conversion to open surgery had occurred in 4 (8%) patients. BMI >32.5, history of cholecystitis previous abdominal surgery, gall bladder wall thickness >3mm, pericholecystic collection, liver brosis were signicant predictive factors of difcult laparoscopic cholecystecomy. There were no signicant predictive factors for conversion to open surgery on analysis in this study. The clinical and ultrasonographi Conclusion c ndings help to predict a difcult laparoscopic cholecystectomy. This information is useful to the patient and operating surgeon. The conversion rate from laparoscopic cholecystectomy to open cholecystectomy was 8% and there were no signicant predictive factors for it on analysis in this study