Publication Details
Abstract
Background: Laparoscopic cholecystectomy (LC) is the primary treatment of symptomatic gallstones. But in one out of six procedures, the procedure is likely to be technically challenging because of inflammation and adhesions, which leads to more vascular and biliary complications.
Aim: This research was conducted to determine and assess preoperative predictors of LC difficulty.
Methods: It was a prospective clinical study that was carried out in Al-Kindy Teaching Hospital, Baghdad, between May 1, 2023, and December 1, 2024. The sample population was comprised of 320 patients who were undergoing LC due to acute or chronic calculous cholecystitis. The data that was gathered before the surgery included age, gender, comorbidities, body mass index (BMI), smoking history, history of acute cholecystitis, and a history of prior abdominal surgery. The laboratory parameters were the white blood cell count, C-reactive protein and the erythrocyte sedimentation rate. At least 24 hours preoperative ultrasound assessment of the gallbladder was conducted to determine the nature of the gallbladder in terms of wall thickness, stones that are impacted, and pericholicystic collection. The cases were considered easy or difficult LC based on intraoperative findings. The analysis of the variables in clinical, laboratory, and ultrasonographic variables was carried out with respect to their association with the difficulty of the operative procedure, duration, as well as the outcomes.
Results: It was found that 47 cases (14.7%) had difficult LC, and 273 cases (85.3) were considered easy. In 30 cases (9.4%), there was spillage of bile stones, in 19 cases (5.9%), there was vascular or bile duct injury, in 6 cases (1.9%), conversion to open surgery, and in 39 cases (12.2%), prolonged operative time (>60 minutes). The age of more than 50 years was also significantly higher in the difficult group (44.7 vs. 24.9, P = 0.005). Difficulty (28.2 ± 5.7 vs. 25.3 ± 4.2 kg/m 2, P = 0.011), as well as smoking history (42.6% vs. 28.2%, P = 0.048) was also correlated with higher BMI. Major ultrasound predictors were a gallbladder wall thickness exceeding 4 mm (P = 0.001), presence of impacted stones (P = 0.002) and presence of pericholecystic collection (P = 0.005).
Conclusion: Diversity of ultrasound results: Old age, increased BMI, smoking, and the presence of ultrasound-detected signs in the pericholecystic collection (thickness of the gallbladder wall, presence of impacted stones, and presence of pericholecystic collection) are important predictors of difficulty in LC. The early detection of these factors can enhance the planning of surgery and prevent complications.