Pre operative prediction of difficult laparoscopic cholecystectomy

Yamini Priyadarshini, Adusumilli (2015) Pre operative prediction of difficult laparoscopic cholecystectomy. Masters thesis, PSG Institute of Medical Sciences and Research, Coimbatore.


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INTRODUCTION: Gall stone disease affects 3 to 20 % of the people living worldwide. Most of the gallstones remain asymptomatic throughout. Only some patients with gall stones show symptoms like biliary colic, jaundice, fever, etc. Usually pain is caused when there is obstruction of the cystic duct by a calculus. Gallbladder removal (Cholecystectomy) is the choice of treatment for all gallbladder diseases which are symptomatic and asymptomatic, unless the patient have increased risk to undergo surgery under general anesthesia. Among cholecystectomies, laparoscopic procedure is accepted widely as the gold standard procedure of choice. Laparoscopic cholecystectomy since its introduction has revolutionized minimally invasive surgery within a short period of twenty years. Laparoscopic cholecystectomy have various advantages like decreased morbidity, decreased stay in hospital, better cosmesis and short time for recovery. However not all laparoscopic cholecystectomies can be finished the same way, conversion to open cholecystectomy is required in some patients. Among all the laparoscopic cholecystectomies performed worldwide 3 to 10 % need conversion to open cholecystectomy. Various factors are responsible for the conversion of laparoscopic to open cholecystectomy like in cases of acute cholecystitis, anatomic anomalies, massive fibrosis, old age, male gender, history of upper abdominal surgeries and pancreatitis , lack of appropriate laparoscopic instruments, gallbladder wall thickness of more than 3mm, presence of pericholecystic fluid, intra operative complications like uncontrolled bleeding, injury to the internal organs. Previous conducted studies predicted the conversion of laparoscopic to open cholecystectomy using various scoring systems, but the scoring systems were not been extensively incorporated into surgical practice due to various reasons. In this study we will assess these pre operative risk factors and their correlation to the difficulty in laparoscopic cholecystectomy. AIM OF THE STUDY: To access the preoperative predictability of difficult laparoscopic cholecystectomy based on the following predictors like age more than or equal to 50 years, BMI more than or equal to 30 kg / sq.m, male gender, past history of acute cholecystitis or pancreatitis, past history of upper abdominal surgery, gallbladder wall thickness more than or equal to 3mm, presence of pericholecystic fluid, total WBC counts more than or equal to 10,000 cells/ cumm. Study area: Department of General Surgery, PSG Hospitals Study period: March 2014 to September 2014. METHODOLOGY: All the patients above 18 years, who underwent cholecystectomy for symptomatic gallbladder disease were included in the study. It is a prospective observational study. History and clinical examination was done in all patients. Ultrasound abdomen and routine blood investigations were done in all the patients. Following variables – male Gender, Age ≥ 65 yrs, BMI ≥ 30, Past history of cholecystitis, pancreatitis and history of upper abdominal surgeries, Total WBC counts >10000 cells/cumm, Presence of gallbladder wall thickness ≥ 3 mm and pericholecystic fluid collection. Difficult laparoscopic cholecystectomy was assessed in terms of duration of surgery in minutes. Analysis of various preoperative risk factors and their relation to the outcome variables was performed using t test. P value of < 0.05 is considered as significant. RESULTS: significant predictive factors for difficult laparoscopic cholecystectomy were gall bladder wall thickness ≥ 3mm, WBC count > 10000cells/cumm, presence of pericholecystic fluid collection. CONCLUSIONS: Preoperative findings of Gallbladder wall thickness more than or equal to 3mm, total WBC count more than or equal to 10,000 cells/ and presence of peri cholecystic fluid collection can help in the prediction of difficult laparoscopic cholecystectomy. Other factors like old age (≥ 65 years), male gender, past history of cholecystitis and pancreatitis, history of upper abdominal surgeries and BMI ≥ 30 were not helpful in predicting difficult laparoscopic cholecystectomy preoperatively.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Gall bladder ; laparoscopic cholecystectomy ; open cholecystectomy ; difficult laparoscopic cholecystectomy.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 10 Jul 2018 03:35
Last Modified: 26 Sep 2018 02:55

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