PREOPERATIVE PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A SCORING METHOD

Dr. Gagandeep Sandhu; Dr. Madhu Lata Rana

Volume : VI, Issue : VI, June - 2016

PREOPERATIVE PREDICTION OF DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A SCORING METHOD

Dr. Gagandeep Sandhu, Dr. Madhu Lata Rana

Abstract :

 AIMS AND OBJECTIVE: To identify various factors which can be used to predict the outcome of the laparoscopic cholecystectomy preoperatively and to devise a reliable scoring method using these factors .MATERIAL AND METHODS: The present prospective study included ultrasonographically proved 50 patients of symptomatic cholelithiasis, operated as elective cases. These patients were admitted in Surgical Wards of Adesh Institute of Medical Sciences and Research, Bathinda. Laparoscopic Cholecystectomy was performed on all the 50 patients using the standard American technique. The patients were selected randomly. Relevant history, clinical examination and investigations were recorded. Pre operative scores were given prior to surgery according to scoring sheet .The consent of all these patients were taken. All the patients were subjected to same general anesthesia, antibiotics, perioperative analgesics and intravenous fluids. Surgery was performed by the consultants of a single unit. Exclusion criteriaPatients with history of jaundice, uncontrolled diabetes mellitus, uncontrolled hypertension & cholangitis ,patients with underlying bleeding diathesis ,Patients with chronic cardiac, pulmonary & renal disease,Patients with concomitant malignant disease, Patients with raised Alkaline phosphatase , SGOT, SGPT,Patients with sonographically proven choledocholithiasis or dilated common bileduct, Patients with history of drug allergy, steroids intake and chemotherapy,Patients on oral contraceptive pills & pregnancy, Patients unfit for general anaesthesia.Parameters recorded were Duration of surgery , From time of 1st trocar insertion to the last port closure,Intraoperative bile and calculus spillage ,Injury to the CBD,Injury to cystic artery.,Conversion to open cholecystectomy. RESULTS AND CONCLUSION ROC (Receiver operator curve) analysis of our study has shown that a score of >5 predicts difficult outcome with sensitivity of 80% and specificity of 97.5% and area under ROC (0.846) shows that preoperative scoring is a good method to predict outcome of LC (laparoscopic cholecystectomy).Hence it can be concluded that the preoperative scoring is statistically and clinically a good test for predicting the operative outcome in LC (area under ROC = 0.846). H/O hospitalisation, BMI, GB wall thickness, pericholecystic collection & impacted calculus in GB have significant beå on the outcome.