Preoperative Clinical and Radiological Variables for Prediction of Difficult Laparoscopic Cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy (LC) has replaced open technique as the main surgical intervention in the treatment of gall bladder stones. There are different clinical and radiological predictors that are indicators for technically difficult LC. Aim of the work: The aim of this study was to identify the clinical and radiological variables associated with difficult LC. Methods: During the period from March 2018 to March 2021, 452 adult patients who presented with symptomatic gall bladder stones underwent LC. Different clinical and radiological data were collected as: abdominal scar, palpable gall bladder, previous hospitalization, history of ERCP, total leucocyte count, thickness of the gall bladder wall, peri-cholecystic collection, solitary or multiple gall bladder stones, impacted stone and diameter of the CBD. Results: Age of 50 years or over (P value 0.001), male gender (P value 0.001), previous hospital admission (P value 0.001), impacted stones (P value 0.003), and leukocytosis (P value 0.031) were found statistically significant with area under ROC curve is 0.814 with 95 % confidence interval. Conclusion: These preoperative risk factors; old age, male gender, previous hospitalization for biliary problem, impacted stone, and leukocytosis could potentially predict difficult LC, and give surgeons and their assistants the chance to predict the risk of complications intraoperatively and the possibility to convert the maneuver to a bail-out one.