Assessment of Predictors of Difficult Laparoscopic Cholecystectomy by Clinico-Radiological Parameters at a Tertiary Hospital in Eastern India.

BACKGROUND

Laparoscopic cholecystectomy has become the standard treatment for gallbladder (GB) stones, favored for its minimally invasive approach. Despite its benefits, the procedure sometimes requires conversion to open cholecystectomy due to intra-operative challenges, with conversion rates varying between 1% and 13%. There are various preoperative predictors that help in identifying such difficult cases and help to proceed safely. This study aims to identify the preoperative factors that could predict the difficulty of laparoscopic cholecystectomy, thus anticipating the need for conversion to open surgery.

METHODS

A prospective observational study was conducted at RIMS Ranchi, India, from May 2023 to May 2024, including a total of 93 patients with gallstone disease who underwent laparoscopic cholecystectomy. Clinical history including age, gender, presence of acute cholecystitis, previous attacks, and previous upper abdominal surgery; biochemical markers including white blood cell (WBC) count, total bilirubin and alkaline phosphatase (ALP), and ultrasonographic findings such as GB wall thickness, stone impacted at the neck of GB, contracted or distended GB, presence of pericholecystic fluid collection, Mirizzi's syndrome and others were analyzed to identify predictors of conversion.

RESULTS

Of the 93 patients included in our study, there were 28 males and 65 females with a ratio of 1:2.3. The age group varied from 14 to 72 years with conversion to open cholecystectomy seen between the age group of 31-70 (mean age 49 years). We observed that 10 patients (conversion rate of 10.75%) underwent conversion from laparoscopic to open cholecystectomy. Significant predictors included acute cholecystitis, multiple previous attacks, and ultrasonographic findings of contracted GB.

CONCLUSION

Preoperative identification of patients at higher risk for conversion can enhance surgical planning and patient counseling, potentially improving outcomes in laparoscopic cholecystectomy.