Page 45 - World Journal of Laparoscopic Surgery

Difficult Laparoscopic Cholecystectomy
Table 1: Preoperative ultrasonographic findings with their incidence of easy and difficult laparoscopic cholecystectomy
Level
Ultrasonography findings Findings Easy Difficult Total p-value
GB wall thickness ≤4 mm 51 (79.7%) 13 (20.3%) 64 0.000
>4 mm 9 (25.0%) 27 (75.0%) 36
GB size <5 cm 8 (80.0%) 2 (20.0%) 10 0.308
≥5 cm 52 (57.8%) 38 (42.2%) 90
CBD size <6 mm 53 (62.4%) 32 (37.6%) 85 0.253
≥6 mm 7 (46.7%) 8 (53.3%) 15
Size of calculus <1 cm 46 (70.8%) 19 (29.2%) 65 0.003
≥1 cm 14 (40.0%) 21 (60.0%) 35
GB stone motility Mobile 55 (68.8%) 25 (31.3%) 80 0.000
Impacted 5 (25.0%) 15 (75.0%) 20
Pericholecystic fluid collection No 44 (72.1%) 17 (27.9%) 61 0.002
Yes 16 (41.0%) 23 (59.0%) 39
GB, gallbladder

Table 2: Diagnostic accuracy of preoperative ultrasonographic findings for predicting the difficult laparoscopic cholecystectomy.
Diagnostic accuracy
Ultrasonography findings Sensitivity (%) Specificity (%) PPV (%) NPV (%) Accuracy (%)
GB wall thickness (>4 mm) 67.5 85.0 75.0 79.7 78
GB size (≥5 cm) 95.0 13.3 42.2 80.0 70
CBD size (≥6 mm) 20.0 88.3 53.3 62.4 46
Size of calculus (≥1 cm) 52.5 76.7 60.0 70.8 61
GB stone motility (impacted) 37.5 91.7 75.0 68.8 67
Pericholecystic fluid collection (yes) 57.5 73.3 59.0 72.1 67
GB, gallbladder; PPV, positive predictive value; NPV, negative predictive value

a rise in preoperative USG score, the percentage of difficult Table 3: Preoperative ultrasonography score with their incidence of easy
laparoscopic cholecystectomies done is higher. and difficult laparoscopic cholecystectomy
Among the 100 patients, 60 patients had an easy laparoscopic Laparoscopic cholecystectomy
cholecystectomy and 40 patients had a difficult cholecystectomy. Preoperative
USG score Easy Difficult Total p-value
dIscussIon 0–1 20 (87.0%) 3 (13.0%) 23 0.000
Determining the factors that can predict a difficult laparoscopic 2–3 40 (65.6%) 21 (34.4%) 61 0.000
cholecystectomy preoperatively based on ultrasound findings was ≥4 0 16 (100.0%) 16 0.000
the aim of our study. Our primary objective was to validate a cut-off
score from the score formulated by preoperative ultrasonography Table 4: Diagnostic accuracy of preoperative ultrasonography score for
findings that are specific to the GB and thereby predicting a difficult predicting the difficult laparoscopic cholecystectomy
laparoscopic cholecystectomy. In our study, we also tried to find the
most commonly associated finding that is specific to the GB that Diagnostic accuracy
correlates with a difficult laparoscopic cholecystectomy. Preoperative Sensitivity Specificity PPV NPV Accuracy
There are many Western works of literature available that USG score (%) (%) (%) (%) (%)
studied the relationship between preoperative ultrasonography 0–1 13.0 51.95 7.5 66.67 43.0
findings and intraoperative surgical outcomes. In India, there
are not that many studies available to correlate preoperative 2–3 34.4 51.28 52.5 33.33 41.0
ultrasonography findings and intraoperative surgical outcomes. ≥4 100.0 71.43 40.0 100.0 76.0
In this study, we took a total of six parameters that are PPV, positive predictive value; NPV, negative predictive value
significant in predicting GB pathology. They were of the thickness
of more than 4 mm of the wall of the GB, size of distension of the more than or equal to 1 cm, and the existence of fluid collection
GB of more than or equal to 5 cm, the CBD caliber size of more than around the GB. The surgical outcomes were divided into easy
or equal to 6 mm, GB stone impacted at the neck, GB stone size difficult and very difficult based on the intraoperative findings

World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022) 231