A prospective cohort study for prediction of difficult laparoscopic cholecystectomy

Veselin Stanisic; Miroslav Milicevic; Nikola Kocev; Balsa Stanisic

doi:10.1016/j.amsu.2020.11.082

A prospective cohort study for prediction of difficult laparoscopic cholecystectomy

Ann Med Surg (Lond). 2020 Dec 1:60:728-733. doi: 10.1016/j.amsu.2020.11.082. eCollection 2020 Dec.

Authors

Veselin Stanisic¹, Miroslav Milicevic², Nikola Kocev³, Balsa Stanisic⁴

Affiliations

¹ Center for Digestive Surgery Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Montenegro.
² The First Surgical Clinic, Clinical Center of Belgrade, Serbia and School of Medicine Belgrade, University of Belgrade, Serbia.
³ Institute for Medical Statistics and Informatics, Faculty of Medicine, Belgrade, Serbia.
⁴ Center for Vascular Surgery Clinical Center of Montenegro, Montenegro.

Abstract

Introduction: Difficult laparoscopic cholecystectomy (DLC) is a stressful condition for surgeon which is followed by greater risk for various injuries (biliary, vascular etc.) Preoperative factors that are related to DLC are landmarks for surgeon to assess the possibilities for overcoming difficulties and making early decision about conversion to an open surgery. In prospective cohort study we evaluated and defined the importance and impact of preoperative parameters on difficulties encountered during surgery, defined DLC, predictors of DLC and index of DLC.

Materials and methods: All patients in the study were operated by the same surgeon. We defined the total duration of the operation as the time from insertion of Veress needle to the extraction of gallbladder (GB) and DLC as a laparoscopic cholecystectomy (LC) that lasted longer than the average duration of LC and the value of one standard deviation.

Results: Multivariate logistic regression analysis identified five predictors significantly related to DLC: GB wall thickness > 4 mm, GB fibrosis, leukocytosis ˃10 × 10⁹ g/L, ˃ 5 pain attacks that lasted longer than 4 h and diabetes mellitus. The sensitivity of the generated index of DLC in our series is 81.8% and specificity 97.2%.

Conclusion: Preoperative prediction of DLC is important for the surgeon, for his operating strategy, better organization of work in operating room, reduction of treatment expenses, as well as for the patient, for his timely information, giving a consent for an operation and a better psychological preparation for possible open cholecystectomy (OC).

Keywords: AH, -acute cholecystitis; BMI, - body mass index; CRP, -C-reactive protein; DLC, difficult laparoscopic cholecystectomy; Difficult laparoscopic cholecystectomy; GB, - gallbladder; LC, -laparoscopic cholecystectomy; OC, - open cholecystectomy; Preoperative prediction; US, ultrasound; WBC, -white blood cell counts.