PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY USING CLINICAL AND ULTRASONOGRAPHY PARAMETERS
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2018, Vol 7, Issue 13
Abstract
BACKGROUND Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic gall stones due to decreased postoperative pain, earlier oral intake, shorter hospital stay, early resumption of normal activity and improved cosmesis. Laparoscopic cholecystectomy may be rendered difficult because of various problems encountered during surgery such as difficult in access to the peritoneal cavity, creation of pneumoperitoneum, gall bladder dissection or extraction of the excised gall bladder. This provoked an interest in studying the factors that could predict the successful completion of the early laparoscopic cholecystectomy. The aim of this study is to define specific parameters for predicting difficulty of laparoscopic cholecystectomy pre-operatively. MATERIALS AND METHODS We conducted a prospective, observational study on 50 cases of symptomatic cholelithiasis who underwent laparoscopic cholecystectomy at our institute during a period of 1 year. Patients with choledocholithiasis or prior history of partial cholecystectomies and suspicion of malignancy were excluded from the study. Various clinical and radiological parameters were noted and the patients were scored to predict difficulty in surgery. Assessment of the difficulties encountered in terms of duration of surgery, bleeding during surgery, difficult access to peritoneal cavity, gall bladder bed dissection, conversion to open cholecystectomy and post-operative morbidity and hospital stay were noted and results were compared to the pre-operative scores. RESULTS Factors such as age, abdominal scar and BMI had no role in the conversion of laparoscopic cholecystectomy. Prior history of an acute attack, palpable and thickened gall bladder, presence of pericholecystic fluid, impacted stone in gall bladder neck had effect on determining the difficulty of laparoscopic cholecystectomy. CONCLUSION Selection of patients for laparoscopic cholecystectomy is must to avoid all these preventable complications.
Authors and Affiliations
Anju Bhagtana, Neelkamal Singh, Anuj Mahajan, Tejinderpal Singh, Aaina Malhotra
Keywords
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- EP ID EP412100
- DOI 10.14260/jemds/2018/375
- Views 102
- Downloads 0
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