Intraoperative Predictors of Difficult Laparoscopic Cholecystectomy: AMU Scoring System

Abstract

bstrAct Introduction: With laparoscopy being the surgeon’s first choice even in difficult cholecystectomy, a need to objectively grade intraoperative difficulty during laparoscopic cholecystectomy (LC) is gaining popularity. The study was done to design a scoring system to predict the difficult outcome during intraoperative LC. Materials and methods: The study was done at the General Surgery Department in a tertiary level hospital among patients undergoing LC. The procedures that exceeded 70 minutes in duration and/or converted to open were considered the difficult LC. To develop the predictive score, an association of various factors with difficult cholecystectomy was identified by performing multiple logistic regression analysis, and receiver operating characteristic (ROC) curve was plotted to estimate the cutoff value for the scoring system. Results: We recruited 200 patients in this study, out of which 85 had difficult cholecystectomy procedures. Among all intraoperative predictors, adhesions, gallbladder (GB) condition, Calot’s triangle status and abnormality, and the presence of pericholecystic fluid were associated with a difficult LC. Based on the odds ratio, a new scoring system was designed with a score ranging from 0 to 25. The grading score was created as easy (0 – 5) and difficult (6 or above) based on the intraoperative factors. At a cutoff score of 6, this scoring system had a sensitivity and specificity of 87.1 and 88.7 % , respectively. Conclusion: This study demonstrates that an intraoperative scoring system can predict the difficult outcome of LC. This can help in minimizing the complication and conversion to open cholecystectomy, especially relevant for funds-limited settings like India.