PriMera Scientific Surgical Research and Practice (ISSN: 2836-0028)

Research Article

Volume 5 Issue 2

Predictors of a Difficult Laparoscopic Cholecystectomy

Leandro V Torre*, Cenon R Alfonso, Alyssa Katrin O Chang and Jeryl Anne Silvia R Reyes

January 31, 2025

View PDF

Abstract

Laparoscopic cholecystectomy (LC) is the gold standard for surgical treatment of cholecystitis with gallstones. In one of the Philippines’ high-volume centers for LC which does about 600 procedures a year, the authors retrospectively reviewed 2,698 records from January 2017 to December 2021 to identify significant factors associated with difficult LC. The authors identified common clinical, biochemical and radiologic factors that affected the difficulty level of such procedure. Patients predicted to have a high risk of difficult LC should be scheduled for longer operating room slots, informed of possibility of longer hospitalization and monitored more closely postoperatively. This information may help the institution improve efficiency. This study showed that around 21.98% of the patients had difficult LC. Almost all (99.2%) were considered difficult as the procedure lasted for more than two hours. Among the 18 laparoscopic surgeries converted to open, 88.89% were because there was failure to identify the critical view of safety. The overall conversion-to-open rate was 0.67 %. There are predictive factors that can be assessed preoperatively to anticipate the difficulty of a laparoscopic cholecystectomy such as being male, per unit increase in body mass index (BMI), having a history of jaundice, having a history of fever, history of laparoscopic abdominal surgery and having right upper quadrant tenderness. Radiologic factors also strongly associated with difficult LC are thickened gallbladder wall, dilated common bile duct, impacted gallbladder stone, pericholecystic fluid, cirrhosis, and per centimeter increase in size of the largest stone.

Keywords: Cholecystectomy; Cholecystitis; Conversion; Difficult; Gallbladder; Gallstones; Laparoscopy; Laparoscopic; Predictors

References

  1. He XiangYi and Shi Jian. “Consensus on diagnosis and treatment of chronic cholecystitis and gallstones in China”. J Clin Hepatol 35.6 (2019): 1231-1236.
  2.  Keus F., et al. “Laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis”. Cochrane Database of Systematic Reviews 4 (2006): CD006231.
  3. Gurusamy KS., et al. “Early versus delayed laparoscopic cholecystectomy for people with acute cholecystitis”. Cochrane Database of Systematic Reviews 6 (2013): CD005440.
  4. Thangavelu A, Rosenbaum S and Thangavelu D. “Timing of Cholecystectomy in Acute Cholecystitis”. J Emerg Med 54.6 (2018): 892-897.
  5. Sakpal SV, Bindra SS and Chamberlain RS. “Laparoscopic cholecystectomy conversion rates two decades later”. JSLS 14.4 (2010): 476-483.
  6. Bhandari TR, Khan SA and Jha JL. “Prediction of difficult laparoscopic cholecystectomy: An observational study”. Ann Med Surg (Lond) 72 (2021): 103060.
  7. StataCorp. Stata 14.0 IC. College Station, TX: StataCorp (2015).
  8. Firth D. “Bias reduction of maximum likelihood estimates”. Biometrika 80.1 (1993): 27-38.
  9. Mansournia MA., et al. “Separation in Logistic Regression: Causes, Consequences, and Control”. American Journal of Epidemiology 187.4 (2018): 864-70.
  10. Inoue K., et al. “Risk factors for difficulty of laparoscopic cholecystectomy in grade II acute cholecystitis according to the Tokyo guidelines 2013”. BMC Surgery 17.1 (2017): 114.
  11. Philip Rothman J., et al. “Preoperative Risk Factors for Conversion of Laparoscopic Cholecystectomy to Open Surgery - A Systematic Review and Meta-Analysis of Observational Studies”. Dig Surg 33.5 (2016): 414-23.
  12. Wennmacker SZ., et al. “Predicting operative difficulty of laparoscopic cholecystectomy in patients with acute biliary presentations”. ANZ J Surg 89.11 (2019): 1451-1456.
  13. Nidoni R., et al. “Predicting Difficult Laparoscopic Cholecystectomy Based on Clinicoradiological Assessment”. J Clin Diagn Res 9.12 (2015): PC09-12.
  14. Griniatsos John. “Factors predisposing to conversion from laparoscopic to open cholecystectomy”. Annals of Laparoscopic and Endoscopic Surgery 3 (2018): 12-12.
  15. Onoe S., et al. “A preoperative predictive scoring system to predict the ability to achieve the critical view of safety during laparoscopic cholecystectomy for acute cholecystitis”. HPB 19 (2017): 406-10.
  16. Bourgouin S., et al. “How to predict difficult laparoscopic cholecystectomy? Proposal for a simple preoperative scoring system”. Am J Surg 212 (2016): 873-81.
  17. Wevers KP, van Westreenen HL and Patijin GA. “Laparoscopic cholecystectomy in acute cholecystitis: C-reactive protein level combined with age predicts conversion”. Surg Laparosc Endosc Percutan Tech 23 (2013): 163-6.
  18. Suman Baral, Raj Kumar Chhetri and Neeraj Thapa. “Utilization of an Intraoperative Grading Scale in Laparoscopic Cholecystectomy: A Nepalese Perspective”. Gastroenterology Research and Practice (2020).
  19. Koichi Inukai. “Predictive Factors for a Long Postoperative Stay after Emergency Laparoscopic Cholecystectomy Using the 2013 Tokyo Guidelines: A Retrospective Study”. Minimally Invasive Surgery (2019).
  20. Gupta N., et al. “Validation of a scoring system to predict difficult laparoscopic cholecystectomy”. Int J Surg 11.9 (2013): 1002-6.