Validation of a Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Nepalese Perspective

  • Suman Baral Lumbini Medical College and Teaching Hospital https://orcid.org/0000-0003-0906-138X
  • Neeraj Thapa Lumbini Medical College and Teaching Hospital
  • Raj Kumar Chhetri Lumbini Medical College and Teaching Hospital
Keywords: Conversion, Laparoscopic cholecystectomy, Preoperative prediction

Abstract

Introduction: Preoperative prediction of the factors leading to difficulty or conversion in cholecystectomy could help plan the surgical strategies and possible outcomes beforehand. The present study aimed to predict and analyze risk factors using a scoring system deemed responsible for surgical difficulties in patients undergoing cholecystectomy for symptomatic cholelithiasis. Methods: This hospital based prospective study was conducted at Department of Surgery, Lumbini Medical College and Teaching Hospital, Nepal. Various factors considered preoperatively were gender, age, previous history of hospitalization, impacted stone, obesity, gall bladder wall thickness, pericholecystic collection, previous abdominal scar and palpable gall bladder. Results: Among 177 cases operated, the mean age ±SD of the patients was 47.72±17.54 years. Conversion rate was 7.9 %. At preoperative score of 5; sensitivity, specificity, positive predictive value and negative predictive value were 89.40% (CI: 83.36%-93.82%), 69.23% (CI: 48.21 %-85.67%), 94.41%(CI: 90.44%-96.79%) and 52.94% (CI: 39.85%-65.64%) respectively{Area under curve– 0.74, p=0.0001, CI (0.637-0.846)}. Multivariate analysis showed abdominal scar {p=0.02, OR (CI): 5.2 (1.2-21.8)}, previous hospitalization {p=0.001, OR(CI): 6.8(2.2-20.8)} and thickened gall bladder wall {p= 0.03, OR(CI): 3.6(1.1-11.5)} to be statistically significant risk factors. Conclusion: With possible prediction beforehand, high risk group of patients can be identified and dealt accordingly to generate good surgical outcome avoiding complications.

Downloads

Download data is not yet available.

Author Biographies

Suman Baral, Lumbini Medical College and Teaching Hospital

Lecturer,

Department of Surgery.

Neeraj Thapa, Lumbini Medical College and Teaching Hospital

Assistant Professor,

Department of Surgery

Raj Kumar Chhetri, Lumbini Medical College and Teaching Hospital

Professor and Head,

Department of Surgery.

References

Acar T, Kamer E, Acar N, Atahan K, Bağ H, Hacıyanlı M, et al. Laparoscopic cholecystectomy in the treatment of acute cholecystitis: comparison of results between early and late cholecystectomy. Pan Afr Med J. 2017;26:49.PMID: 28451027 DOI:10.11604/pamj.2017.26.49.8359

Suliman E, Palade RȘ, Suliman E. Importance of cystic pedicle dissection in laparoscopic cholecystectomy in order to avoid the common bile duct injuries. J Med Life. 2016;9(1):44-48. PMID: 27974912

Gupta N, Ranjan G, Arora MP, Goswami B, Chaudhary P, Kapur A, et al. Validation of a scoring system to predict difficult laparoscopic cholecystectomy. Int J Surg. 2013;11(9):1002- 1006. PMID: 23751733 DOI: 10.1016/j.ijsu.2013.05.037

Abdel Baki NA, Motawei MA, Soliman KE, Farouk AM.Pre-operative prediction of difficult laparoscopic cholecystectomy using clinical and ultrasonographic parameters. JMRI. 2006;27(3):102-107.

Agrawal N, Singh S, Khichy S. Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method. Niger J Surg. 2015;21(2):130-133. PMID: 26425067 DOI: 10.4103/1117-6806.162567.

Hayama S, Ohtaka K, Shoji Y, Ichimura T, Fujita M, Senmaru N, et al. Risk Factors for Difficult Laparoscopic Cholecystectomy in Acute Cholecystitis. JSLS. 2016;20(4):e2016.00065. PMID: 27807397 DOI: 10.4293/JSLS.2016.00065.

Randhawa JS, Pujahari AK. Preoperative prediction of difficult lap chole: a scoring method. Indian J Surg. 2009;71(4):198-201. PMID: 23133154 DOI: 10.1007/s12262-009-0055-y

Lim JU, Lee JH, Kim JS, Hwang YI, Kim TH, Lim SY. Comparison of World Health Organi¬zation and Asia-Pacific body mass index clas¬sifications in COPD patients. Int J Chron Ob¬struct Pulmon Dis. 2017;12:2465-2475. PMID: 28860741 DOI: 10.2147/COPD.S141295.

Chesney T, Acuna SA. Do elderly patients have the most to gain from laparoscopic surgery? Ann Med Surg (Lond). 2015;4(3):321-323. PMID: 26557989 DOI: 10.1016/j.amsu.2015.09.007.

Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007;14(1):91- 97.PMID: 17252302 DOI: 10.1007/s00534-006-1161-x

Radunovic M, Lazovic R, Popovic N, Magdelinic M, Bulajic M, Radunovic L, et al. Complications of Laparoscopic Cholecystectomy: Our Experi¬ence from a Retrospective Analysis. Open Access Maced J Med Sci. 2016;4(4):641-646. PMID: 28028405 DOI: 10.3889/oamjms.2016.128

Nassar AHM, Hodson J, Ng HJ, Vohra RS, Kat¬beh T, Zino S, et al. CholeS Study Group, West Midlands Research Collaborative. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc. 2019; [Epub ahead of print]. PMID: 31732855 DOI: 10.1007/s00464-019-07244-5.

Amin A, Haider MI, Aamir IS, Khan MS, Chou¬dry KU, Amir M,et al. Preoperative and Opera¬tive Risk Factors for Conversion of Laparoscop¬ic Cholecystectomy to Open Cholecystectomy in Pakistan. Cureus. 2019;11(8):e5446.PMID: 31637145 DOI: 10.7759/cureus.5446.

Terho PM, Leppäniemi AK, Mentula PJ. Lapa¬roscopic cholecystectomy for acute calculous cholecystitis: a retrospective study assessing risk factors for conversion and complications. World J Emerg Surg. 2016 ;11:54. PMID: 27891173 DOI: 10.1186/s13017-016-0111-4

Ashfaq A, Ahmadieh K, Shah AA, Chapital AB, Harold KL, Johnson DJ. The difficult gall blad¬der: Outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg. 2016 ;212(6):1261-1264. PMID: 28340928 DOI: 10.1016/j.amjsurg.2016.09.024

Bourgouin S, Mancini J, Monchal T, Calvary R, Bordes J, Balandraud P. How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system. Am J Surg. 2016 ;212(5):873-881. PMID: 27329073 DOI: 10.1016/j.amjsurg.2016.04.003

Kanakala V, Borowski DW, Pellen MG, Dronamraju SS, Woodcock SA, Seymour K, et al. Risk factors in laparoscopic cholecystectomy: a multivariate analysis. Int J Surg. 2011;9(4):318- 323. PMID: 21333763 DOI: 10.1016/j.ijsu.2011.02.003

Stanisic V, Milicevic M, Kocev N, Stojanovic M, Vlaovic D, Babic I, et al. Prediction of difficulties in laparoscopic cholecystectomy on the base of routinely available parameters in a smaller regional hospital. Eur Rev Med Pharmacol Sci. 2014;18(8):1204-1211. PMID: 24817296

Tiong L, Oh J. Safety and efficacy of a laparoscopic cholecystectomy in the morbid and super obese patients. HPB (Oxford). 2015;17(7):600- 604. PMID: 25906816 DOI: 10.1111/hpb.12415

Geraci G, D’Orazio B, Rizzuto S, Cajozzo M, Modica G. Videolaparoscopic cholecystectomy in patients with previous abdominal surgery. Per¬sonal experience and literature review. Clin Ter. 2017;168(6):e357-e360.PMID: 29209684 DOI: 10.7417/T.2017.2034

Chand P, Singh R, Singh B, Singla RL, Yadav M. Preoperative Ultrasonography as a Predictor of Difficult Laparoscopic Cholecystectomy that Requires Conversion to Open Procedure. Niger J Surg. 2015;21(2):102-105. PMID: 26425061 DOI: 10.4103/1117-6806.162573

Hu ASY, Menon R, Gunnarsson R, de Costa A. Risk factors for conversion of laparoscopic cholecystectomy to open surgery - A systematic literature review of 30 studies. Am J Surg. 2017;214(5):920-930. PMID: 28739121 DOI: 10.1016/j.amjsurg.2017.07.029

Livingston EH, Rege RV.A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004;188(3):205-211.

Ghnnam W, Malek J, Shebl E, Elbeshry T, Ibrahim A. Rate of conversion and complications of laparoscopic cholecystectomy in a tertiary care center in Saudi Arabia. Ann Saudi Med. 2010;30(2):145-148. PMID: 20220265 DOI: 10.4103/0256-4947.60521

Published
2020-06-02
How to Cite
1.
Baral S, Thapa N, Chhetri R. Validation of a Preoperative Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Nepalese Perspective. J Lumbini Med Coll [Internet]. 2Jun.2020 [cited 9Jul.2020];8(1):7 pages. Available from: https://jlmc.edu.np/index.php/JLMC/article/view/323
Section
Original Research Article