Assessment of difficult Laparoscopic cholecystectomy based on clinical and radiological findings
Author(s): Manjunath Irappa Wali, Anupama Pujar K and Koteswararao Mukkapati
Abstract:Background: Laparoscopic cholecystectomy is common procedure done in minimal invasive procedures. It is the treatment of choice for symptomatic gall stone disease all around the world. Methodology: This is case control study done in 198 patients undergoing laparoscopic cholecystectomy. Patients randomly divided as case and controls based on preoperative clinical criteria and radiological features. Results: 198 patients underwent laparoscopic cholecystectomy. Their mean age was 46.19 ± 13.03 years. There was female preponderance with 143 (72.2%) females as compared to 55 (27.8%) males. Difficult cholecystectomy was labelled in 55 (27.8%) cases based on intra-operative criteria mentioned in methodology. 13 (6.6%%) required conversion to open cholecystectomy. Easy cholecystectomies scored 0.81 as compared to 8.18 in the difficult group. The sensitivity of the preoperative score in predicting difficult cases was 98.2% with the specificity of 95.8%; positive predictive value of 90.0% and the negative predictive value of 99.3%%. The accuracy of the pre-operative scoring system was 96.56%. The area under the ROC curve (AUROC) for Preoperative Score predicting Surgery Difficulty: Difficult vs Surgery Difficulty: Easy was 0.992 (95% CI: 0.983 - 1), thus demonstrating excellent diagnostic performance. Conclusion: The preoperative score has high sensitivity, specificity, and accuracy in predicting difficult cases and can be used for identifying difficult laparoscopic cholecystectomies.