Page 35 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Preoperative Scoring System to Predict Difficult

Laparoscopic Cholecystectomy

1
Sajay Reddy , Sreeramulu PN 2

AbstrAct
Background: Laparoscopic cholecystectomy (LC) is considered as the most common laparoscopic procedure in the world and is now the Gold
standard treatment for cholelithiasis. Gallstone disease (cholelithiasis) has increasingly become one of the major causes of abdominal pain and
discomfort in the developing world. Its occurrence has been found to be high (7.4%) in the adult population in the cities of Chandigarh and New
Delhi in North India, which is one of the highest in the world. Gallstones are more common in the female population (61%) as compared to males
(39%). The most common age-group affected is 45–60 years (38.5%) among females and above 60 years in males (20.8%). A relatively higher
prevalence of 39% among males when compared to reports from past studies indicates a significant shift in the pattern of prevalence of gallstone
disease. Many risk factors for cholelithiasis cannot be modifiable, such as ethnic background, advancing age, female gender, family history or
genetics. The modifiable risks for cholelithiasis are obesity, quick weight loss, an idle lifestyle. A rising epidemic of obesity and the metabolic
syndrome predicts an escalation in gallstones. Frequent risk factors for biliary sludge include pregnancy, drugs like ceftriaxone, octreotide, and
thiazide diuretics, total parenteral nutrition, and fasting. Diseases like cirrhosis, chronic hemolysis, and Crohn’s disease are a few risk factors for
black pigment stones. In our hospital setup (RL Jalappa Hospital and Research Center, Tamaka, Kolar, Karnataka), in the Department of Surgery,
a total of 166 cholecystectomies were performed in the period between October 2015 and September 2018. In total, 134 of these cases were
elective laparoscopic cholecystectomy and twenty five of them were elective open cholecystectomies. There were a total of 7 cases that had
to be changed from laparoscopic to open procedure due to intraoperative difficulty involved. That gives us a conversion rate of 4.96% over the
past 3 years in our hospital setup. Preoperative prediction for the likelihood of conversion to open or difficulty of operation is an important
aspect of planning laparoscopic surgery as the prevalence of gallbladder disease is increasing in India, and laparoscopic surgery is becoming
more accessible. Arogya Karnataka Scheme, which can be used in our hospital setup, has laparoscopic cholecystectomy as one of its schemes
for impoverished patients bringing the chance of laparoscopic surgery to the public. As a result, the number of laparoscopic cholecystectomies
as a whole as well as the risk of conversion increases, making the need for study all the more important.
Aims and objectives: (1) To validate that a scoring system based on history, physical examination, and ultrasonographic findings is a reliable
predictor of the difficulty of laparoscopic cholecystectomy. (2) To help in choosing a favorable treatment modality depending on the score.
(3) To help predict the duration of hospital stay and postoperative complications with the help of this system.
Methods: A prospective and comparative study, considering 70 patients admitted and undergoing laparoscopic cholecystectomy at RL Jalappa
Hospital and Research Center attached to Sri Devaraj Urs Academy of Higher Education Tamaka, Kolar, during the period of November 2018
and 10th October 2020.
Results: The preoperative scoring system devised is excellent at predicting the intraoperative difficulties encountered by surgeons while
performing laparoscopic cholecystectomy with a sensitivity of 88.9% and a specificity of 92.3%. The scoring system also predicted intraoperative
complications with a specificity of 94.2% when the score is >7. There was also a very strong correlation between the preoperative score and
the duration of surgery (r = 0.752, p <0.001) and also between the preoperative score and the duration of hospital stay (r = 0.788, p <0.001).
Conclusion: Preoperative prediction of the risk of conversion or difficulty of operation is an important aspect of planning laparoscopic surgery.
I would conclude that the scoring system evaluated in our study can be used to predict difficult cases.
Keywords: Cholecystectomy, Laparoscopic, Predictive factors, Preoperative, Scoring system.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1532

IntroductIon 1,2 Department of General Surgery, Sri Devraj Urs Medical College,
Gallbladder diseases are a relatively common disorder in large parts Kolar, Karnataka, India
of the world. The prevalence of cholelithiasis in the USA and much Corresponding Author: Sreeramulu PN, Department of General
1,2
of Western Europe is between 10 and 20%. The prevalence is seen Surgery, Sri Devraj Urs Medical College, Kolar, Karnataka, India, Phone:
to increase with age in both sexes. However, it has been observed +91 9845316361, e-mail: Drsreeramulupn@yahoo.co.in
around the world that gallbladder diseases are predominantly a How to cite this article: Reddy S, Sreeramulu PN. Preoperative Scoring
disease affecting females. System to Predict Difficult Laparoscopic Cholecystectomy. World J Lap
In India too, the gallstone disease follows the pattern seen in Surg 2022;15(2):131–139.
Western countries and is relatively common with overall prevalence Source of support: Nil
4,5
3
in the order of 10–20% and affecting females predominantly. Conflict of interest: None
6
The results in this issue of the journal by Gaharwar et al. are no
different.
There is a difference in the burden of gallbladder diseases of prevalence of gallstone disease has seen a significant shift when
between Northern and Southern states in India (commoner in compared to past studies, with a higher than expected prevalence
North), a phenomenon which is poorly understood. 5–8 The pattern of 39% among males. 9
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