Pre–operative detection of safe laparoscopic cholecystectomy in acute cholecystitis

Malika Singh; Prem Chand; D.P.Singh; Abhinav Singh

Volume : VII, Issue : III, March - 2018

Pre–operative detection of safe laparoscopic cholecystectomy in acute cholecystitis

Malika Singh, Prem Chand, D. P. Singh, Abhinav Singh

Abstract :

The purpose of the study was to assess pre–operative predictors of safe early laparoscopic cholecystectomy (LC) in acute cholecystitis (AC). The study was conducted in the Department of General Surgery Government Medical College/ Rajindra Hospital Patiala. Total of 100 consecutive cases of AC were undertaken for early LC. Excluded were the patients with mass formation, coagulation disorders, pregnancy, unfit for general anaesthesia and not consented for conversion of LC into open cholecystectomy (OC). Various parameters critically analyzed were age more than 65 years, male gender, history of attacks of AC, previous abdominal surgery, previous endoscopic retrograde cholengio–pancreaticography (ERCP), BMI >30, deranged liver function tests (LFTs), contracted or distended gall bladder (GB), pericholecystic collection, multiple stones and gangrenous gall bladder, and accordingly the status of ease of LC was categorized as Easy LC, Reasonably/ Relatively easy LC, Moderately difficult LC, Difficult LC, Very difficult LC and Severely difficult LC as per the locally designed grading system based on three main concerns and observations of the operating surgeon while completing the whole procedure of LC, and these include time taken for completion of LC, injury to artery or duct and the conversion to open cholecystectomy. Out of 100 cases of LC, 69 were easy LC, 18 were reasonably/ relatively easy LC, 9 were moderately difficult LC, 3 were difficult LC and one was very difficult LC. This very difficult LC was due to prolonged operative time, injury to artery and bleeding and the necessity of its conversion to open cholecystectomy because of the obscured Calot�s triangle as a result of previous history of attacks of AC, deranged LFTs, multiple stones, pericholecystic collection, gangrenous GB and male gender. Females, absence of history of attacks of AC, no previous abdominal surgery, normal LFTs, non contracted, non distended and non gangrenous GB, single stone, absence of pericholecystic collection and cholecysto–enteric fistula, and clear visualization of Calot�s triangle with normal anatomy are all preoperative predictors of early safe LC. Age more than 65 years, obesity and previous ERCP were not predictors for very difficult LC. However, such categorization of LC in a given case is dependent upon the experience and expertise of the operating surgeon.