Abstract
Introduction: The first laparoscopic cholecystectomy performed by Prof Dr Eric Muhe in 1985. In India it was first done in 1990 at the JJ Hospital, Mumbai, which was considerably late compared to European and North American countries. Laparoscopic cholecystectomy was then adopted rapidly around the world and was finally recognized as the new gold standard surgical procedure in the management of gallstone disease. Conditions like inflammations, dense adhesions, anomalies, intra-operative trauma to bile duct and massive hemorrhage may make the laparoscopic procedure difficult. This study aims at analyzing specific variables for their significance to predict difficult laparoscopic cholecystectomy.
Methods: A cross sectional study was conducted from August 2018 to July 2020. All the cases of cholelithiasis planned for laparoscopic cholecystectomy were included in the study. The patient’s socio-demographic data and relevant clinical history was recorded in preformed proforma. Haematological, biochemical, and imaging parameters were recorded pre-operatively. Data collected were analyzed using SPSS-version-21. Percentage, mean and standard deviation were used. Chi-square test and Fisher’s exact test were used for proportions. A p-value of <0.05 was taken as significant.
Results: 156 patients were recruited for the study and 39.7% were males. 4 (2.6%) of them were below 30 years of age, 78 (50%) of them were between 30-40 years, 64 (41.0%) were between 41-50 years and 10 (6.4%) of them were above 50 years. Out of 156 laparoscopic cholecystectomies, 19 were difficult (12.2%). Male gender, ESR, TLC, AST, ALT, serum amylase and CRP level were significantly associated with difficult laparoscopic cholecystectomy. Wall thickness of GB, free fluid around GB and size of the stone were significantly associated with difficult laparoscopic cholecystectomy.
Conclusion: Male patient with nine out of twelve preoperative factors (ESR>20mm/1st hour, TLC>10x109/lit, AST>40IU/lit, ALT>50IU/lit, amylase>120IU/lit, CRP>5mg/lit, wall thickness of the GB>4mm, presence of free fluid around GB, size of largest stone>2cm) could significantly predict difficult laparoscopic cholecystectomy and thereby preparedness on the high probability of conversion from laparoscopic cholecystectomy to open cholecystectomy.