The surprise of difficult complicated laparoscopic cholecystectomy: a preoperative predictive scoring system to avoid it

Introduction and aim Laparoscopic cholecystectomy (LC) has been accepted as the procedure of choice for management of troublesome gallbladder stones. (a) Difficult LC is a challenging problem, and still iatrogenic injuries occur. (b) This study aims to evaluate a preoperative score that predicts difficulty of LC. The benefit of such valuable scoring tool is to choose the suitable procedure and surgeon for each patient, which would give best results and fewer complications. Background The more a technique is practiced and spread, the more the need to assess its results and technique based on evidence-based medicine. (c) Difficult cholecystectomy is a problem that general surgeons encounter commonly. Common bile duct injuries have a serious postoperative morbidity and mortality potential. (d) We focused our effort to develop and validate an easy scoring system to predict difficult LC preoperatively. Patients and methods This is a prospective study that included 100 patients who underwent LC at Assiut university hospitals. The operator for all cases was the same experienced surgeon. There were 17 variables from history, clinical examination, radiological, and laboratory findings. Difficult LC was defined as the duration of surgery in minutes is longer than average operative time for the same experienced surgeon. Results It was noticed that patients with difficult LC had significantly higher mean age (49.11 +/- 5.56 vs. 40.78 +/- 12.07 years; P<0.001), BMI (31.65 +/- 4.92 vs. 21.16 +/- 2.60 kg/m(2); P<0.001), previous history of upper abdominal operations (0 vs. 10%; P=0.02), acute cholecystitis (6.7 vs. 42.5%; P<0.001), acute pancreatitis (1.7 vs. 15%; P=0.01), thick gallbladder wall (6.75 vs. 47.5%; P<0.001), and high alkaline phosphatase (15 vs. 37.5%; P=0.01) in comparison with those with easy LC. Mean operative time was 82.50 +/- 27.84 min. A total of 60 (60%) cases were classified as easy LC, whereas 40 (40%) cases were classified as difficult LC. Conclusion We could predict difficult LC cases preoperatively with the help of this scoring system, and hence, high-risk patients may be informed regarding the probability of conversion and choose the best suitable surgeon accordingly.