Page 47 - World Journal of Laparoscopic Surgery

Difficult Laparoscopic Cholecystectomy
in our study. Preoperative ultrasound findings such as thickness of of ultrasonography findings was anticipated. Laparoscopy surgery
more than 4 mm of the wall of the GB, size of distension of the GB compared to open surgery needs extra time to become an expert in it
of more than or equal to 5 cm, the CBD caliber size of more than or and as the surgery itself a skill-based technique it differs from surgeon
equal to 6 mm, GB stone impacted at the neck, GB stone size more to surgeon. To make it to have some standard, all radiologists and
than or equal to 1 cm and the existence of fluid collection around the surgeons with a minimum of more than 10 years of experience in their
GB were given a grade of 1 or 0 based on findings being affirmative respective field were performing the investigation and the surgery.
or dissent. The sums of the grade were taken and were interrelated
with the difficult laparoscopic cholecystectomy. Intraoperative clInIcAl sIgnIfIcAnce
findings, namely, injury and damages made to the bile duct, CBD or
artery, the existence of thick adhesions on the GB sides, region of the Compared with open cholecystectomy, laparoscopic cholecys-
Calot’s being frozen, ripped up GB and spillage of bile and stones, tectomy has obvious advantages of reduced cost, decreased hos-
unusual and atypical anatomy, bleeding that hamper and obstruct pital length of stay, reduced morbidity, better cosmetic scar, and
the visual field and time taken of 60–120 minutes were considered increased patient satisfaction. For these reasons, the laparoscopic
as difficult laparoscopic cholecystectomy. cholecystectomy is now considered as the gold standard surgical
Four preoperative findings, namely, the thickness of more than treatment of choice for cholelithiasis. It will be useful to have some
4 mm of the wall of the GB, GB stone impacted at the neck, GB authentic factors (USG findings) to prognosticate difficulty, conver-
stone size more than or equal to 1 cm, and the existence of fluid sion, or complications in laparoscopic cholecystectomy.
collection around the GB had statistical significance in anticipating
a difficult laparoscopic cholecystectomy. An elevated preoperative references
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equal to 4 from the ultrasonography formulated grading method ciated with use of systemic thromboembolic prophylaxis during
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