Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy

Introduction: Laparoscopic cholecystectomy is one of the most common operation performed.Though LC have become safer and easier at times it can be dif cult. Dif cult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. Identication of dif cult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict dif cult LC preoperatively. Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict dif cult LC which was compared with operative assessment. Results: Sensitivity and speci city of the preoperative scoring for dif cult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically signi cant to predict dif cult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883).  Conclusions: Preoperative scoring system can be used to predict dif cult LC. Surgeons can plan operation based on predicted difculty. Patients and relatives can be counselled preoperatively for the possibility of dif cult operation, prolonged hospital stay and increased cost in predicted difcult case. Keywords: Dif cult cholecystectomy; Laparoscopic cholecystectomy; Symptomatic cholelithiasis