How to Predict A Difficult Laparoscopic Cholecystectomy?
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- Category: Vol. 85, September 2017
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How to Predict A Difficult Laparoscopic Cholecystectomy?, TAMER A. AL-NAIMY, TAHA A. BAIOMY and EHAB M. ORABY
Abstract
Background: Laparoscopic Cholecystectomy (LC) is the procedure of choice for management of gall stone disease. LC is relatively easy and can be done quickly but in some cases LC may be difficult and takes longer time and need special instruments intra-operatively.
Methods: There were 250 laparoscopic cholecystectomy cases in 31 months during the period from September 2013 to March 2016. Examined preoperative parameters were age, sex, onset of pain, previous attacks of acute cholecystitis, previous obstructive jaundice with or without Endoscopic Retrograde Cholangio-Pancreatography (ERCP), previous abdominal surgery, gall bladder wall thickness and size and number of gall bladder stones.
Results: Difficult LC was found in 120 patients. Twenty patients had been converted to open cholecystectomy (16.7%). Parameters like body mass index >30, empyema of gall bladder, thick-walled gall bladder, large size stones, increased number of stones, increased number of attacks of acute cholecystitis and previous endoscopic retrograde cholangio-pancreatography are found of statistical significance and can be used as criteria for predicting difficult LC.
Conclusion: Some pre-operative parameters can predict the chances of conversion to the open procedure and the complications during LC. The patients are informed of the possibility of complications and conversion to the open procedure.