Assessing Patient Preoperatively and Role in Decreasing Risks on Patients and Preventing Post-Operative Complications for Cholecystectomy
Keywords:Laparoscopic cholecystectomy, difficulty, conversion, Iraq
Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissection
of the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of the
Gallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patient
preoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operative
complications. Patients and Methods: A prospective study conducted in the department of General Surgery
at Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February
2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patients
with common bile duct calculus, dilated common bile duct, current attack of acute cholecystitis, those with
absolute contraindications to laparoscopic cholecystectomy, The data were collected prospectively to predict
the significance of association with patients’ characteristics. The time of operation was calculated from the
first port site incision until the last port closure. All the intra operative events were recorded. Conversions
to open cholecystectomy were done by median or subcostal laparotomy according to the surgeon’s decision
and each patient’s condition. Results: In this study, the highest proportion of operations was categorized
as easy (58.3%), 28.3% of operations were considered difficult and 13.3% of them were very difficult. A
significant association (P < 0.05) between operation difficulty and all of the following characteristics: Aging,
obesity, history of previous biliary hospitalization, thickened bladder wall, pericholecystic collection, and
large stones. Conclusions: The difficult laparoscopic cholecystectomy can be predicted preoperatively
based on number of factors, like: obesity, previous biliary admission, gall bladder wall thickness, ultrasound
findings (stone size and pericholecystic fluid) and aging process, evaluating of such factors minimize the
complications of laparoscopic cholecystectomy and conversion to the open procedure.
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