Introduction

Cholecystectomy is the most common elective procedure performed on hepato-biliary system. Laparoscopic cholecystectomy has become the gold standard for benign gallbladder disease in very short time¹. Sometimes Laparoscopic cholecystectomy becomes difficult when there is congenital arterial, ductal or structural anamoly of gallbladder is present². Acute inflammation with gangrenous gallbladder, dense adhesions, small, fibrotic, thick walled gall bladder, cholecysto-enterocholic fistula will cause difficulty in performing Laparoscopic cholecystectomy. Other risk factors³ like old age, male sex, obesity, clinical signs of acute cholecystitis, prior upper abdominal surgery, impacted stones, and pericholecystic fluid will further add to difficult Laparoscopic cholecystectomy.⁴

Preoperative prediction of conversion or difficulty atsurgery is an important aspect of planning Laparoscopic cholecystectomy. An accurate prediction may become necessaryfor counselling the patient and their attendants regarding conversion to open cholecystectomy. The surgeon may get indication so that he may accordingly schedule the time and team for surgery. Patients may be informed for longer hospitalisation and more intense post operative care. Hospital administration may manage their admission and bed vacancy efficiently.

Objectives

The objective of the study was to predict difficult Laparoscopic cholecystectomy and to establish relationship between the preoperative clinical and diagnostic evaluation. 

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Dr Radhika Raman

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