January-March 2018

Study of Correlation of Preoperative Clinical Findings, Laboratory Investigations and Sonological Findings on Peroperative Parameters in Gall Stone Disease

I A Juneja1, D A Baraiya2, J G Bhatt3, J P Dave4, Siju Samuel5

1,4Associate Professor, 2,5Resident Doctor, 3Professor, Dept. Of Gen. Surgery, P.D.U. Govt. Medical College, Rajkot


BACKGROUND AND OBJECTIVES: Within a short span of merely two decades since its introduction, laparoscopic cholecystectomy (LC) has become widely accepted as the procedure of choice for symptomatic gall bladder disease. The degree of difficulty is again impossible to predict. Our objective is to study clinical findings, sonological and investigational findings which can predict difficulty and overall outcome in Laparoscopic Cholecystectomy. METHODS: This prospective study is carried out in the department of general surgery with 50 caseswith signs and symptoms of cholelithiasis / cholecystitis selected by purposive sampling from November 2015 to October 2017. Uni-variate analysis was performed using the chi square test to determine the preoperative clinical, sonological and investigational factors that were associated with difficulty in LC. RESULTS: The common reasons for difficulty in our studies were as follows: dense adhesions(24%), spillage of bile(20%), intra operative bleeding(22%), difficulty in dissection of calot’s triangle (32%), spillage of gall bladder stones(4%), difficulty in extraction of gall bladder(16%) and difficulty in port placement(18%).Clinical factors like obesity (BMI >/=25kg/m2 ) investigation like altered LFT and sonological finding like size of the stone , gall bladder wall thickness >3mm and pericholecystic oedema can help to predict difficult laparoscopic cholecystectomy and conversion to open. CONCLUSION: With proper preoperative assessment of clinical, investigational and sonological parameters the best possible results can be imparted to the patient undergoing laparoscopic cholecystectomy. Conversion is neither a failure nor a complication but it is an attempt to minimize the complications.

Keywords: laparoscopic cholecystectomy, conversion, pre-operative parameters

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