Diagnostic Power of the Proposed Scoring System for Predicting Laparoscopic Cholecystectomy Difficulty

Recognition of influential factors is necessary for predicting the severity of cholecystectomy. We aimed to evaluate the diagnostic power of the proposed scoring system for predicting the severity of laparoscopic cholecystectomy.

 In this cross-sectional study, there were 122 patients who underwent cholecystectomy in Shahid Beheshti Hospital during 2018. Prior to surgery, accurate history, and clinical, laboratory, and ultrasound information were recorded and scored on a checklist. Finally, the difficulty of cholecystectomy was divided into three categories of easy (less than 60 minutes, uncomplicated) and difficult (between 60 and 90 minutes, divided into controllable) and very difficult (between 90 and 120 minutes with uncontrollable complications or open surgery). Data were analyzed in SPSS software, version 22, and the indicators were calculated for the purpose of the study.

There were 28 (22.4%) men and 97 (77.6%) women. The mean±SD ages of the patients in easy and difficult operations were 44.71±13.56 and 44.52. 14.56 years, respectively (p=0.939). The patients’ sex and history of acute cholecystitis attacks did not have a significant relationship with the difficulty of laparoscopic cholecystectomy (p ≥0.05). However, between the palpable gallbladder (p <0.0001), impacted stone (p <0.0001), gallbladder wall thickness (p <0.0001), and body mass index above 30 (p <0.0001) there was a statistically significant relationship between the difficulty of operation. There was also a significant relationship between AST (p =0.034), T Bill (p =0.008) WBC (p <0.0001), and the difficulty of laparoscopic cholecystectomy, but between ALT (p =0.065), the severity of cholecystectomy was not significantly related. Sensitivity (86%), specificity (58%), positive predictive value (44%) and negative predictive value (91%) were calculated for the scoring system for the difficulty of laparoscopic cholecystectomy.

 To predict the difficulty of laparoscopic cholecystectomy, we strongly recommend the preoperative scoring system. It is also recommended to conduct further studies on the use of the scoring system during surgery.