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A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy

*, Mittalgodu Anantha Krishna Murthy Vivek and Augustine, Alfred Joseph and Rao, Ranjith (2014) A comprehensive predictive scoring method for difficult laparoscopic cholecystectomy. Journal of Minimal Access Surgery, 10 (2). pp. 62-67.

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Abstract

CONTEXT: Laparoscopic cholecystectomy (LC) is the gold standard cholecystectomy. LC is the most common difficult laparoscopic surgery performed by surgeons today. The factors leading to difficult laparoscopic cholecystectomy can be predicted. AIMS: To develop scoring method that predicts difficult laparoscopiccholecystectomy. SETTINGS AND DESIGN: Bidirectionalprospective study in a medical college setup. MATERIALSAND METHODS: Following approval from the institutionalethical committee, cases from the three associated hospitals in a medical college setup, were collected using a detailed preform a stating the parameters of difficulty in laparoscopic cholecystectomy. Study period was between May 10 and June 12. Preoperative, sonographic and intraoperative criteria were considered. STATISTICALANALYSIS USED: Chi Square test and Receiver Operater Curve (ROC) analysis. RESULTS: Total 323patients were included. On analysis, elderly patients,males, recurrent cholecystitis, obese patients, previous surgery, patients who needed preoperative Endoscopic retrograde cholangiopancreatography (ERCP), abnormal serum hepatic and pancreatic enzyme profiles, distended or contracted gall bladder, intra-peritoneal adhesions, structural anomalies or distortions and the presence of a cirrhotic liver on ultrasonography (USG) were identified as predictors of difficult LC. A scoring system tested against the same sample proved to be effective. A ROC analysis was done with area under receiver operator curve of 0.956A score above 9 was considered difficult with sensitivity of 85% and specifi city of 97.8%. CONCLUSIONS: This studydemonstrates that a scoring system predicting the difficulty inLC is feasible. There is scope for further refinement to make thesame less cumbersome and easier to handle. Further studiesare warranted in this direction.

Item Type: Article
Uncontrolled Keywords: Cholecystectomy, diffi cult cholecystectomy, laparoscopy, laparoscopic cholecystectomy, minimal access surgery
Subjects: Medicine > KMC Mangalore > Surgery
Depositing User: KMCMLR User
Date Deposited: 16 Apr 2014 07:19
Last Modified: 16 Apr 2014 07:19
URI: http://eprints.manipal.edu/id/eprint/139392

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