Selvakumar, S (2020) A Prospective study of Pre Operative Predictors of Difficult Laparoscopic Cholecystectomy. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
BACKGROUND: Cholelithiasisis the most common biliary pathology, with a prevalence of 10 to 15%. It is symptomatic in approximately 1 to2% of patients. N I H consensus development stated that laparoscopic cholecystectomy “Provides a Safe and Effective treatment for most patients with symptomatic gallstones”. In about 5 to 10% of laparoscopic cholecystectomy, conversion to open cholecystectomy may be needed for safe removal of gall bladder. OBJECTIVES: 1. To determine the predictive factors for difficult laparoscopic cholecystectomy. 2. To study the clinical presentation of cholelithiasis. METHODS: The material for the present study comprised of 51 cases admitted to Govt Kilpauk Medical College from April 2019 to October 2019 for a period of 6 months. The cases confirmed by Ultrasonography were evaluated with following risk factors: age > 50years, male sex, BMI 25.1 to 27.5 and >27.5, previous surgery, prior hospitalization, palpable gall bladder, gall bladder wall thickening, impacted stone, pericholecystic fluid collection. Each risk factor was given a score. The total score upto 5 predicted easy, 6 to 10 difficult and more than 10 very difficult. RESULTS: The highest age incidence of cholelithiasis was in the 3rd decade, and was more common in females. Pain abdomen was the most common symptom. Ultrasonography detected gall bladder stones in all patients, wall thickening in 26 and pericholecystic fluid collection in 10. BMI > 27.5 (P < 0.005), history of prior hospitalization (P < 0.008), impacted stone (P < 0.014) were significant predictors of difficult laparoscopic cholecystectomy. INTERPRETATION AND CONCLUSION The proposed scoring system had a positive prediction value was 100% and negative prediction value was 86.05%, Sensitivity was 67.14%, Specificity was 100%. The conversion rate from laparoscopic cholecystectomy to open cholecystectomy was 10%.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221711162 |
| Uncontrolled Keywords: | Laparoscopic Cholecystectomy, Predictive Factors, Scoringsystem. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Feb 2021 16:11 |
| Last Modified: | 10 Feb 2021 16:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13992 |
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