A prospective cohort study for prediction of difficult laparoscopic cholecystectomy. (December 2020) - Stanisic, Veselin
Abstract: Introduction: Difficult laparoscopic cholecystectomy (DLC) is a stressful condition for surgeon which is followed by greater risk for various injuries (biliary, vascular etc.) Preoperative factors that are related to DLC are landmarks for surgeon to assess the possibilities for overcoming difficulties and making early decision about conversion to an open surgery. In prospective cohort study we evaluated and defined the importance and impact of preoperative parameters on difficulties encountered during surgery, defined DLC, predictors of DLC and index of DLC. Materials and methods: All patients in the study were operated by the same surgeon. We defined the total duration of the operation as the time from insertion of Veress needle to the extraction of gallbladder (GB) and DLC as a laparoscopic cholecystectomy (LC) that lasted longer than the average duration of LC and the value of one standard deviation. Results: Multivariate logistic regression analysis identified five predictors significantly related to DLC: GB wall thickness > 4 mm, GB fibrosis, leukocytosis ˃10 × 10 9 g/L, ˃ 5 pain attacks that lasted longer than 4 h and diabetes mellitus. The sensitivity of the generated index of DLC in our series is 81.8% and specificity 97.2%. Conclusion: Preoperative prediction of DLC is important for the surgeon, for his operating strategy, better organization of work in operating room, reduction of treatment expenses, as well as for the patient, for his timely information, giving a consent for an operation and a better psychological preparation for possible open cholecystectomy (OC). Highlights: H There is no consensus on the definition of difficult laparoscopic cholecystectomy (DLC) and its treatment. We defined DLC as an operation that lasts longer than the average duration of LC and the value of one standard deviation. DLC is a possible introduction to conversion but not an inevitable pathway to conversion. The precise consensus on predictors of DLC hasn't been made. Thickened GB wall > 4 mm, GB fibrosis, >5 attacks of disease and pain lasting > 4 hours, WBC >10 x10 9 g/L and diabetes mellitus are predictors of DLC.