Simple and Reliable Scoring System to Predict Difficult Laparoscopic Cholecystectomy Preoperatively

A bstrAct Aim and objective: To validate the efficacy of proposed scoring system compared to the Randhawa scoring system in prediction of difficult laparoscopic cholecystectomy (LC) preoperatively. Materials and methods: A prospective study was conducted including 102 patients who underwent LC for symptomatic cholelithiasis. Preoperatively a score was given to the patient according to both scoring systems. Final outcome was decided on intraoperative findings of operative time, adhesions, and bile spillage. Univariate and multivariate analyses of preoperative factors were done. Receiver operating characteristic (ROC) curves of both the scoring system were compared, and the results were reported as a difference in proportion (95% CI). p value < 0.05 was considered as statistically significant. Results: The specificity and positive predictive value of the modified scoring system were 92 and 95.1% which was higher than Randhawa scoring system, i.e., 76 and 87.5%. Area under ROC curve was also more in modified scoring system. Also, univariate analysis found age > 50 years, history of hospitalization, previous endoscopic retrograde cholangiopancreatography, diabetes mellitus, palpable gallbladder, gallbladder wall thickness, and contracted gallbladder on ultrasound to be statistically significant factors. Conclusion: The proposed modified scoring system significantly increases the specificity and positive predictive value of the Randhawa scoring system. This scoring system is easy to perform, require no additional investigation and can effectively categorize patient where LC will be difficult. Clinical significance: The proposed scoring system can effectively predict difficult preoperatively which would help in better preoperative preparation by the surgical team for a difficult laparoscopic cholecystectomy. Patients can be optimally counseled preoperatively so that they are well prepared for various outcomes of the procedure.