Volume 5 Issue 3 (March, 2017)

Original Articles

Ashwani Kumar, Ashish Chabra, Bharat Bhushan

Background: Cholecystectomy is one of the commonest surgical procedures performed throughout the world. Various parameters like age, sex, body mass index (BMI), history of previous abdominal surgery, ultrasonography findings of gall bladder wall thickness, contracted gall bladder, peri-cholecystic fluid, size of stone and haematological findings like raise total leucocytes count, alkaline phosphatase; liver enzymes were added in recent studies to predict difficult Laparoscopic Cholecystectomy. This study was conducted to analyse whether these parameters could be used pre-operatively for prediction of difficult laparoscopic cholecystectomy and conversion. Materials & methods: The present study included patients who attended the Outdoor Patient Department (OPD) with history of symptomatic Gallstone Disease were enrolled and elective surgery was performed after clinical assessment, Routine Investigations and Ultrasonography of the abdomen. Patient of all ages and both gender were included in the study. Detail medical history of all patients were recorded, demographic data like age, sex, weight, height and body mass index (BMI) were measured before the surgery. Heamatological blood investigations were done prior to surgery. Special emphasis were given to total leukocyte count (TLC), Alkaline phosphatase (ALP), S.Bilirubin, and liver enzymes. Ultrasonography of the abdomen was done in all patients before surgery and various parameters were recorded. After the surgery, patients were group into 2 categories; those who had a successful laparoscopic cholecystectomy, those cases who had conversion to open cholecystectomy Laparoscopic cholecystectomy was performed in all the patients. All the results were recorded and analyzed by SPSS software.  Results: Age > 50 years was associated with risk of conversion/difficult laparoscopic cholecystectomy. Sensitivity was 95.9% with a positive predictive value of 95%. Conversion rate among male was 27.7% where as in female it was 8.5%.  Body Mass Index (BMI) > 30 kg/m2 had a significant co-relation with risk of conversion to open cholecystectomy Sensitivity was 96.9% and positive predictive value was 94.1%. p value was 0.000, the conversion rate among cases with BMI >30 kg/m2 was 70%. Conclusion: Parameters like age, sex, obesity, history of upper abdominal surgery, raised total leucocytes count etc. are   risks factors and predictors for conversion to open cholecystectomy.
Key words: Cholecystectomy, Laparoscopic, Pre-operative.

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