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Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy
BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder stone disease. This is due to its safety, reliability, cost-effectiveness, negligible mortality, shorter duration of hospitalization (early return to work), better cosmesis, minimal wound complic...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer - Medknow
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771185/ https://www.ncbi.nlm.nih.gov/pubmed/31579368 http://dx.doi.org/10.4103/njs.NJS_3_19 |
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author | Chand, Prem Kaur, Manpreet Bhandari, Sumit |
author_facet | Chand, Prem Kaur, Manpreet Bhandari, Sumit |
author_sort | Chand, Prem |
collection | PubMed |
description | BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder stone disease. This is due to its safety, reliability, cost-effectiveness, negligible mortality, shorter duration of hospitalization (early return to work), better cosmesis, minimal wound complications, and temporary paralytic ileus. In spite of these, conversion to open cholecystectomy which is sometimes required in difficult cases could be challenging. AIMS AND OBJECTIVES: The aim of the present study is to aid the prediction of difficult cases undergoing LC, thereby better selection of patients with the least conversion rates. MATERIALS AND METHODS: This prospective study was conducted on 100 consecutive patients with cholecystitis, over a 2-year period from January 1, 2017, to December 31, 2018, having undergone LC. Various preoperative parameters, including age, sex, previous attacks of cholecystitis, deranged liver functions, and ultrasonographic findings, were analyzed for their effects for predicting the level of difficulty during LC. RESULTS: Twenty-five percent of the cases were correctly predicted as difficult in the age group of >65 years. Cholecystitis was more common (79%) in females, but difficulties were encountered more frequently while performing LC in males. Abnormal serum hepatic and pancreatic enzyme profiles were associated with difficulties during surgery as about 83.3% of the patients predicted as moderately difficult peroperatively had deranged liver functions. The preoperative ultrasonography findings were helpful for predicting the degree of difficulty involved in the procedure. About 33.3% of the patients that had pericholecystic fluid on ultrasound preoperatively were correctly predicted to have moderately difficult surgeries. The Chi-square test and P value were used to determine statistical significance. CONCLUSIONS: Females, the absence of previous repeated attacks of cholecystitis and hospitalizations, no upper abdominal surgery in the past, normal liver function tests, normal amylase levels, nondistended and uncontracted gallbladder, absence of pericholecystic collection, afebrile, and single stone are positive preoperative predictors of safe LC in symptomatic gallbladder stone disease. |
format | Online Article Text |
id | pubmed-6771185 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Wolters Kluwer - Medknow |
record_format | MEDLINE/PubMed |
spelling | pubmed-67711852019-10-02 Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy Chand, Prem Kaur, Manpreet Bhandari, Sumit Niger J Surg Original Article BACKGROUND: Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic gallbladder stone disease. This is due to its safety, reliability, cost-effectiveness, negligible mortality, shorter duration of hospitalization (early return to work), better cosmesis, minimal wound complications, and temporary paralytic ileus. In spite of these, conversion to open cholecystectomy which is sometimes required in difficult cases could be challenging. AIMS AND OBJECTIVES: The aim of the present study is to aid the prediction of difficult cases undergoing LC, thereby better selection of patients with the least conversion rates. MATERIALS AND METHODS: This prospective study was conducted on 100 consecutive patients with cholecystitis, over a 2-year period from January 1, 2017, to December 31, 2018, having undergone LC. Various preoperative parameters, including age, sex, previous attacks of cholecystitis, deranged liver functions, and ultrasonographic findings, were analyzed for their effects for predicting the level of difficulty during LC. RESULTS: Twenty-five percent of the cases were correctly predicted as difficult in the age group of >65 years. Cholecystitis was more common (79%) in females, but difficulties were encountered more frequently while performing LC in males. Abnormal serum hepatic and pancreatic enzyme profiles were associated with difficulties during surgery as about 83.3% of the patients predicted as moderately difficult peroperatively had deranged liver functions. The preoperative ultrasonography findings were helpful for predicting the degree of difficulty involved in the procedure. About 33.3% of the patients that had pericholecystic fluid on ultrasound preoperatively were correctly predicted to have moderately difficult surgeries. The Chi-square test and P value were used to determine statistical significance. CONCLUSIONS: Females, the absence of previous repeated attacks of cholecystitis and hospitalizations, no upper abdominal surgery in the past, normal liver function tests, normal amylase levels, nondistended and uncontracted gallbladder, absence of pericholecystic collection, afebrile, and single stone are positive preoperative predictors of safe LC in symptomatic gallbladder stone disease. Wolters Kluwer - Medknow 2019 /pmc/articles/PMC6771185/ /pubmed/31579368 http://dx.doi.org/10.4103/njs.NJS_3_19 Text en Copyright: © 2019 Nigerian Journal of Surgery http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Chand, Prem Kaur, Manpreet Bhandari, Sumit Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title | Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title_full | Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title_fullStr | Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title_full_unstemmed | Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title_short | Preoperative Predictors of Level of Difficulty of Laparoscopic Cholecystectomy |
title_sort | preoperative predictors of level of difficulty of laparoscopic cholecystectomy |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6771185/ https://www.ncbi.nlm.nih.gov/pubmed/31579368 http://dx.doi.org/10.4103/njs.NJS_3_19 |
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