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Intraoperative Predictors of Laparoscopic Cholecystectomy
Table 1: Predictors of difficult cholecystectomy based on the results of multiple logistic regression analysis
Univariate Multivariate
Predictors OR p-value AOR p-value Score weight
Abdominal wall scar
No scar Ref NA
Scar present 0.94 0.69 NA
Pneumoperitoneum access
Easy access Ref NA
Difficult access by repeated attempt 0.90 0.79 NA
Access requiring open technique 1.76 0.23 NA
Abdominal adhesions
No adhesions Ref Ref 0
Easily separable mild adhesions 0.51 0.54 0.000 0.99 0
Severe adhesions requiring energy 12.10 <0.01 10.87 0.03 1
Intra-abdominal adhesions 8.40 <0.01 39.10 <0.01 4
Intra-abdominal and GB adhesions 14.03 <0.01 225.74 <0.01 5
Buried GB High <0.01 High <0.01 5
GB condition
Normal Ref Ref 0
Distended 5.63 <0.01 10.70 0.04 1
Edematous and inflamed 5.0 <0.01 6.77 0.03 1
Contracted and inflamed 8.36 <0.01 10.51 0.03 2
Congested and inflamed 14.30 <0.01 24.49 0.04 2
Contracted and congested 21.67 <0.01 34.46 <0.01 3
Empyema High <0.01 High <0.01 5
Intraoperative pericholecystic fluid
Absent Ref Ref 0
Present 6.69 0.02 170.46 <0.01 5
Calot’s triangle status
Normal/clear Ref Ref 0
Partial obscure 3.33 0.02 2.00 0.57 0
Cystic duct abnormality 4.44 <0.01 17.98 <0.01 2
Vessel abnormality 35.56 <0.01 524.38 <0.01 5
Partially obscure with cystic duct/vessel
abnormality 17.78 <0.01 229.83 <0.01 5
Fully frozen 53.33 <0.01 222.88 <0.01 5
Hartman pouch status
Normal/no stone Ref Ref 0
Impacted stone High <0.01 High <0.01 5
Intraoperative liver status
Normal Ref NA
Fatty 0.79 0.69 NA
Visceroptosis 1.65 0.37 NA
Need for port enlargement/conversion
No Ref Ref
Yes 2.94 0.01 2.49 0.39 NA
AOR, adjusted odds ratio; OR, odds ratio

a meta-analysis of all on intraoperative LC scoring system taking We observed predicting a difficult LC is possible with good
GB appearance and distension, access, complications, cystic duct, accuracy by our scoring system. In spite of this, our predicting score
and artery identification into account and proposed a new scoring has some limitations. Due to nonrandom sampling, small sample
17
system. This had a score ranging from 0 to 10, with a score of 2 or size, and nonvalidated scoring system, we could not comment
more predicted as moderate to severe difficult LC. 17 on this generability. It is also observed that defining the level

116 World Journal of Laparoscopic Surgery, Volume 14 Issue 2 (May–August 2021)