Significance of preoperative laboratory and radiological parameters in predicting difficult laparoscopic cholecystectomy

Abstract

Introduction: Laparoscopic cholecystectomy is a routine procedure for cholecystitis and cholelithiasis, but at times can have difficulties that may make the surgeon decide for an open cholecystectomy instead. Identification of possible preoperative factors that could allow prediction of difficult laparoscopic cholecystectomies would be of great help to the practicing surgeon.

Objective: To assess the significance of preoperative laboratory and radiological features in prediction of difficult laparoscopic cholecystectomy.

Materials & Methods: A Case Control study was carried out at Rehman Medical Institute, Peshawar, based on the archived medical records of patients diagnosed with cholecystitis and cholelithiasis who underwent Laparoscopic Cholecystectomy (Lap Chole)  from 2014 to 2019. Patients were divided into two cases (difficult Lap Chole) and controls (normal Lap Chole). In the laboratory variables, WBC Count and LFTs (serum bilirubin, ALT and AST) were considered. In the case of radiological variables, CT scan findings were considered. Regression analysis was done to assess the variables. Data were analyzed using SPSS version 26.

Results: With the sample size of 126, 56(44.4%) patients were male and 70(55.6%) were female. The total number of cases were 25(20%) whereas controls were 101(80%) giving a ratio of 1:4. The majority (51%) of patients had no comorbidities; 58(46%) patients had normal WBC count whereas 68(54%) patients had raised WBC count. Fifty six (44.4%)  patients had normal LFTs whereas 70(55.6%)  patients had deranged LFTs. Most common CT finding (29.6%) was acutely inflamed gallbladder with multiple calculi, increased wall thickness and pericholecystic fluid. Univariate Regression analysis identified CT findings and Duration of surgery as significant predictive variables; multivariate regression analysis identified the selected variables as significantly predictive.

Conclusion: Selected preoperative and operative variables such as laboratory and radiological features, and duration of surgery can be useful for prediction of difficult laparoscopic cholecystectomy.