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Subject Area

Dermatology

Article Type

Original Study

Abstract

Background Laparoscopic cholecystectomy (LC) has become the standard procedure of choice for management of symptomatic gallstone disease recently. Sometimes, it is difficult and takes longer time or it may be converted to an open procedure. Aim This study was undertaken to determine the preoperative factors and their predictive value for the difficulty of LC. The study used some important factors preoperatively that have a significant effect in the literature that can predict difficult LC via a scoring method in Menoufia University hospitals. Patients and methods The present retrospective study was conducted by an experienced laparoscopic surgeon in the period of 1 year from October 2018 to October 2019 in the Department of General Surgery at Menoufia University hospitals. The study included 132 patients who underwent LC. A total score up to 15 score from history, clinical, and sonological findings was retrospectively analyzed to evaluate preoperative predictors included in our study. Score up to 5 predicted easy, 6–10 difficult, and more than 10 very difficult LC. All the data was recorded in a tabulated form and analyzed using SPSS software, version 2018. Results The factors included in the score of this study were divided as history factors, such as age, sex, BMI, previous abdominal surgery, and previous hospitalization for biliary causes; clinical factors, such as acute calcular cholecystitis, hydrops (mucocele) or empyema of gallbladder (GB), and acute pancreatitis; and sonological factors such as GB wall thickness, stone impacted at the neck of GB, common bile duct diameter, and pericholecystic fluid collection, and all were grouped to form a scoring method in Menoufia University hospitals that can strongly help the surgeon expect the difficulty of the procedure to be prepared preoperatively with the suitable plan for safety of both the surgeon and the patient. Conclusion The scoring system depending on preoperative factors included in this study was so reliable and useful that it could successfully predict difficult cases.

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