Topno Noor, Khongwar Donkupar, Sharma Girish, Wankhar Baphiralyne, Baruah Arup, Tongper Dathiadiam, Ghosh Sandeep, Naku Narang, Khonglah Yookarin, Hajong Ranendra, Boruah Polina
General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, IND.
Urology, Max Super Speciality Hospital, Delhi, IND.
Cureus. 2024 Nov 22;16(11):e74218. doi: 10.7759/cureus.74218. eCollection 2024 Nov.
Laparoscopic cholecystectomy (LC) is currently the gold standard of care for managing gallstone disease. The time taken to perform LC depends on both patient-related and surgeon-related factors. Recognizing factors associated with difficult LC (DLC) can aid in appropriate surgeon selection and judicious scheduling of cases.
This prospective study was conducted to identify preoperative factors (clinical and ultrasonographic) and intraoperative factors that can help predict or prepare for DLC. The study took place in the Department of General Surgery, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, India. A total of 100 cases of LC were enrolled over a two-year period. All patients had symptomatic cholelithiasis and were scheduled to undergo elective LC. The time taken to perform LC was compared against individual parameters of interest, including clinical features, ultrasonography (USG), and intraoperative findings.
Forty-one LCs were classified as difficult and 59 as non-DLC (NDLC), based on the time limit set by the mean operating time for all LC cases. Seven out of the 41 difficult LCs required conversion to open cholecystectomy (OC). Patient, USG, and intraoperative factors were found to have a significant correlation with difficult LC. Patient factors included male gender, body mass index (BMI), number of past attacks, and previous abdominal surgery. USG factors included calculi number, calculi size, impaction of calculi, and a thick gallbladder (GB) wall. Intraoperative factors included pericholecystic adhesions, Calot's triangle dissection, GB mobilization from the liver bed, and GB specimen extraction.
Preoperative identification of difficult LC cases can guide rational allocation of cases based on surgeon experience, leading to better utilization of operating theatre time and reducing the probability of conversion and complications.
腹腔镜胆囊切除术（LC）是目前治疗胆结石疾病的金标准。实施LC所需的时间取决于患者相关因素和外科医生相关因素。识别与困难LC（DLC）相关的因素有助于进行合适的外科医生选择和明智地安排手术病例。
本前瞻性研究旨在确定可帮助预测DLC或为其做准备的术前因素（临床和超声）及术中因素。该研究在印度西隆东北英迪拉·甘地区域卫生与医学科学研究所普通外科进行。在两年期间共纳入100例LC病例。所有患者均有症状性胆石症且计划接受择期LC。将实施LC的时间与各相关参数进行比较，包括临床特征、超声检查（USG）和术中发现。
根据所有LC病例的平均手术时间设定的时间限制，41例LC被归类为困难手术，59例为非困难LC（NDLC）。41例困难LC中有7例需要转为开腹胆囊切除术（OC）。发现患者、USG和术中因素与困难LC有显著相关性。患者因素包括男性、体重指数（BMI）、既往发作次数和既往腹部手术史。USG因素包括结石数量、结石大小、结石嵌顿和胆囊（GB）壁增厚。术中因素包括胆囊周围粘连、胆囊三角解剖、从肝床游离GB以及取出GB标本。
术前识别困难LC病例可根据外科医生经验指导合理分配病例，从而更好地利用手术室时间并降低转为开腹手术及发生并发症的概率。
