www.ijcmr.com International Journal of Contemporary Medical Research Volume 3 | Issue 4 | April 2016 | ICV: 50.43 | ISSN (Online): 2393-915X; (Print): 2454-7379 1232 Assessment of Operative Predictors for Dificulty in Laproscopic Cholecystectomy Ayanat Husain 1 , Saurabh Pathak 2 , Huma Firdaus 1 ORIGINAL RESEARCH ABSTRACT Introduction: Laparoscopic cholecystectomy from the day of its introduction has aimed at improving the results of tra- ditional surgical treatment and is regarded as gold standard treatment in cholecystitis. The study was aimed to assess var- ious operative predictors for dificult laproscopic cholecystec- tomy. Material and methods: The present prospective study was conducted over 108 patients with diagnosis of cholelithiasis conirmed by abdominal ultrasonography (USG). Surgical procedure was categorized postoperatively into easy, dificult and very dificult surgical procedure on the basis of time taken in minutes, bile/stone spillage, injury to duct and conversion to open cholecystectomy. Data so obtained was analyzed us- ing SPSS-16 data analysis software. Chi square test was used for statistical analysis with p<005 as signiicant value. Results: The present study found that obesity, co-morbid dis- eases, previous history of acute cholecystitis or pancreatitis, delayed surgery after 72 hour of gall bladder inlammation, increased thickness of gallbladder, ibrosis of liver parenchy- ma, multiple stones, size of calculi more than 1 cm are signif- icant factors that result in dificult and very dificult surgical procedures. Conversion to open cholecystectomy was seen in 19 (17%) patients. Conclusion: Patient characteristics indicates a type of laparo- scopic cholecystectomy procedure i.e. easy, dificult or very dificult. Pre-operative prediction of a dificult laproscopic cholecystectomy can help the surgeon to better prepare for risk factors or intra-operative complications and can help to predict the risk of conversion to open cholecystectomy. Keywords: Cholelithiasis; Laparoscopic cholecystectomy; risk factor INTRODUCTION Cholecystectomy was considered as the surgical procedure for cholelithiasis in 1882, when its pioneer Carl Johann Au- gust Langenbuch performed the irst cholecystectomy in a 43-year-old male patient who suffered from gallstone dis- ease over past 16 years. 1 Laparoscopic cholecystectomy is considered as the gold standard treatment for most gallblad- der diseases. 2 The advantages of laparoscopic cholecystec- tomy are earlier return to bowel function, less postoperative pain, cosmetics, shorter length of hospital stay and earlier return to full activity. 3 Laparoscopic cholecystectomy (LC) though considered as safe and effective, yet can become dificult at times due to various problems faced during surgical procedure. Various problems encountered includes problem in identifying anat- omy, anatomical variation, creating pneumoperitoneum, ac- cessing peritoneal cavity, releasing adhesions and extracting the gall bladder. LC with these problems along with time tak- en more than normal are regarded as dificult. 4 The present study was commenced to identify the factors that can predict dificulty in laparoscopic cholecystectomy and thus compli- cations can be prevented beforehand. MATERIAL AND METHODS The present prospective study was conducted over 108 pa- tients aged between 35 to 60 years who underwent a lapa- roscopic cholecystectomy for cholecystitis over a period of 3 years in our institute. Ethical approval was taken from the concerned institutional committee for the commencement of study. Informed consent was taken from the patients. De- tailed clinical history was obtained that included demograph- ic data consisting of age, sex and obesity, history of previous acute attacks, fever and co morbid diseases (hypertension, any cardiovascular disease, etc). Diagnosis of cholelithiasis was conirmed in patients presenting with abdominal symp- toms was done using an abdominal ultrasonography (USG) and the patients who agreed to take part in the study, were randomly selected among them. Leukocyte count, preoper- ative liver function tests, and other laboratory indings were evaluated. Cholecystectomies were performed by experi- enced surgeons in the standard four-port technique. All pa- tients were placed on intravenous antibiotics upon admission which was continued after surgery. All the intraoperative events were recorded and timings were noted from the irst port site incision until the last port closure. Surgical proce- dure was categorized postoperatively into easy, dificult and very dificult surgical procedure on the basis of time taken in minutes, bile/stone spillage, injury to duct and conversion to open cholecystectomy (Table 1 as described by Randha- wa JS et al 5 ). The irst port (10-mm cannula) was inserted in the subumbilical region and three 5–10 mm ports were inserted along the subcostal margin under direct vision at midline, midclavicular and anterior axillary line. Dissection of Calot’s triangle and the gallbladder from the liver bed was accomplished by using monopolar electrocautery. Conver- sions to open cholecystectomy were carried out by median or subcostal laparotomy according to the surgeon’s decision and each patient’s condition. After extraction, specimen was sent for histopathological examination. 1 Associate Professor, 2 Assistant Professor, Department of Surgery, Career medical College and Hospital, Lucknow, India Corresponding author: Ayanat Husain, Associate Professor, De- partment of Surgery, Career medical College and Hospital, Luc- know, India How to cite this article: Ayanat Husain, Saurabh Pathak, Huma Firdaus. Assessment of operative predictors for dificulty in lapro- scopic cholecystectomy . International Journal of Contemporary Medical Research 2016;3(4):1232-1234.