LAPAROSCOPIC CHOLECYSTECTOMY

To assess various intra operative predictive factors which are responsible for difficulty in performing laparoscopic cholecystectomy

Abstract

Objective: To assess various intra operative predictive factors which are
reponsible for difficulty in performing laparoscopic cholecystectomy. Study Design: Prospective
observational study. Place and Duration of Study: This study was out in Surgical department,
Liaquat University Hospital Jamshoro, Dow International Hospital Karachi and Jinnah
Postgraduate Medical Center Karachi, from October 2012 to October 2013. Methodology: This
study consisted of hundred patients. Detailed History was taken from all the patients with special
regard to the abdominal pain or pain in right hypochondrium, lump in right hypochondrium ,
vomiting , dyspepsia and fever. Detailed Clinical examination of the patient was done . Site of right
hypochondrium was especially examined for assessment of murphy’s sign , palpable mass ,
visceromegaly and recorded in proforma. Systemic review was also done to see any comorbidity.
Ultrasound of abdomen as diagnostic modality and for assessment of gallstone
disease. Inclusion criteria were all diagnosed patients of complicated and uncomplicated gall
stone disease of any age and either any sex admitted on the basis of history , clinical examination
and investigations specially ultrasound of abdomen. Exclusion criteria included unfit patients for
general anesthesia , Pregnant ladies due to risk of foetal loss, patient with carcinoma of gall
bladder , patient with acute pancreatitis and Patient with obstructive jaundice. Follow up of all
these patients was done. Results were prepared with help of tables and graphs. Data was
analyzed through SPSS software. Results: Out of 100 patients included in this study 79 were
female (79%) and 21 male (21%); with female to male ratio of 3.76:1. There was wide variation of
age ranging from a minimum of 20 years to 65 years . The mean age was 46.28+7.20 years.
Symptoms of patients presented with pain in RHC 87% , pain in RHC along with pain in
epigastrium 78%, Nausea & Vomiting 15%, dyspepsia 50% and fever in 10% of cases.
Ultrasound examination revealed single stone in 20(20%) patients where as multiple stones in
80(80%) patients. Operative findings revealed severe adhesions in calot’s triangle in 15(15%)
patients where as Severe & tight adhesions around gallbladder in 16(16%) patients, Obscured
anatomy in calot’s triangle in 11(11%) patients and Intrahepatic gallbladder in 9(9%) patients.
Complications were Pain in 33(33%) patients, Bleeding in 1(1%) patients, Intraperitoneal
collection in 2(2%) patients, Wound Sepsis in 5(5%) patients and Biliary leakage in one case.
Conclusions: In conclusion our study revealed that are numerous conditions which make the
difficult laparoscopic cholecystectomy like severe adhesions in calot’s triangle 15%, Severe &
tight adhesions around gallbladder 16%, Obscured anatomy in calot’s triangle 11%, Intrahepatic
gallbladder 9% and adhesions around gallbladder 26%.