VALIDATION OF A SCORING SYSTEM TO PREDICT DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY: A ONE-YEAR CROSS-SECTIONAL STUDY

Abstract

Background: Open cholecystectomy is rapidly being replaced with laparoscopic cholecystectomy which could be associated with complications. Preoperative prediction of risk factors helps in assessing the intraoperative difficulties. Various scoring systems are available to predict the intraoperative difficulties in laparoscopic cholecystectomy. However, there is the need to find a consistent and reliable scoring and predictive system.

Aim: To validate a preoperative scoring system that will predict difficult laparoscopic cholecystectomy.

Design of the study: Non-randomized prospective descriptive study.

Setting: Department of Medicine, K.L.E. University's Dr. Prabhakar Kore Hospital and Medical Research Centre, Belagavi 590003, Karnataka. India.

Methodology: A preoperative score was given to all the patients (30 patients) based on history, clinical examination, and sonographic findings. A score < 5 was predicted as easy, 6-10 as difficult, and 11-15 as very difficult. Intraoperative events such as duration of surgery, bile/stone spillage, and injury to duct/artery were recorded; and surgery was labelled as easy/difficult/very difficult based on these findings. The scores were compared in each patient to conclude the practicality of preoperative predictive score. SPSS version 22 was used to analyze the data.

Results: Gender (P = 0.029), palpable gallbladder (P = 0.04), thick gallbladder wall (P = 0.027), and impacted stone (P = 0.04) were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity of this scoring method were 86.36 % and 75 %, respectively. The positive predictive value for easy and difficult cases, using this scoring method, was 90.48 % and 66.67 %, respectively.

Conclusion: The preoperative scoring system evaluated in study is reliable and beneficial in predicting the difficulty of laparoscopic cholecystectomy. However, further randomized prospective multicentric studies with large sample size are required to validate the efficiency of the scoring system.

Keywords: Cholecystectomy; Cholecystitis; Laparoscopic; Prospective; Scoring system.