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- Title
Validation and Comparison of Pre-Operative and Intra-Operative Scoring Systems to Predict Difficult Cholecystectomy.
- Authors
H. N., Dinesh; R., Abhinandan; V., Sachin; Nayak, Akash
- Abstract
Background Laparoscopic cholecystectomy represents a significant advancement in the treatment of gallbladder stones and cholecystitis, quickly becoming the preferred method over open surgery. It is one of the most frequently performed procedures by general surgeons. This technique offers benefits such as a shorter hospital stay, quicker recovery, improved cosmetic outcomes, and reduced morbidity. However, it is associated with a higher incidence of bile duct injuries compared to open surgery. A crucial part of planning for laparoscopic cholecystectomy involves assessing the potential difficulty of the procedure and the risk of needing to convert to open surgery. Methods This is a prospective observational study done at the Department of General Surgery, Krishna Rajendra Hospital, Mysore over a period of 1 year from September 2022 to September 2023 with a sample size of 100 patients with symptomatic gall stone disease, with informed consent. Pre-operative predictors were recorded, intra-operative predictors were recorded. Difficulty of the surgery was documented. Data was entered and analysed. Results 100 subjects were studied, 78 females and 22 males. 80 of them had <6 preoperative score and 20 of them had 6-10 score. 30 subjects had <2 intraoperative score, 47 had 2-4 score, 19% had 5-7 score and 4% had >7 score. 61 surgeries were easy, 32 were difficult and 7 extremely difficult. There was 1 bile duct injury and 7 conversions to open. Fischer’s exact test used for the two scores found a significant association between the score and the difficulty of laparoscopic cholecystectomy with 71.8% sensitivity and 70.5% specificity for preoperative and 79.5% sensitivity and 73.8% specificity for intraoperative scores (AUC 0.762 and 8.24 respectively p<0.05). History of acute cholecystitis, >4mm wall thickness and pericholecystic collection had significance in predicting difficult laparoscopic cholecystectomy. Conclusions Preoperative and intraoperative scores were both significant predictors for difficult surgery. History of acute cholecystitis, >4mm wall thickness and pericholecystic collection were preoperative factors that independently predicted difficult surgery. Application of these scores and noting the significant preoperative factors will aid appropriate planning and management of laparoscopic cholecystectomies.
- Subjects
SURGERY; GALLSTONES; BILE ducts; LAPAROSCOPIC surgery; SENSITIVITY &; specificity (Statistics); CHOLECYSTITIS; CHOLECYSTECTOMY
- Publication
Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research), 2024, Vol 15, Issue 8, p1360
- ISSN
0975-3583
- Publication type
Article