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  Global Journal of Surgery. Volume 2, Issue 1 (2011) pp. 46-53
  Research Article
Preoperative prediction of difficulty during laparoscopic cholecystectomy
  Muhammad Shamima,*, Khurshid Samob  
a Department of Surgery, Fatima Hospital & Baqai Medical University, Karachi-74600, Pakistan
b Surgical V, Civil Hospital Karachi, Pakistan

  Introduction: To determine the risk factors predicting difficulty during laparoscopic cholecystectomy (LC). Experimental: Surgical V, Civil Hospital and Surgical II, Fatima Hospital (Karachi) between January and November 2008. There were 100 cases of cholelithiasis admitted through out-patient department (OPD) for elective surgery. Clinical features, laboratory investigations and outcome of surgery were recorded on a data collection form. Conversion to open surgery and long operating time were the indicators of difficult laparoscopic dissection. A p-value of <0.05 was considered significant. Results and Discussion: Nine patients required conversion to open surgery, and seven of them were predicted for difficulty. Factors strongly predicting conversion, having p-value <0.05, were: vomiting, previous acute cholecystitis, previous jaundice, tenderness in right hypochondrium, leucocytosis, gallbladder wall thickness of 2mm or more, contracted gallbladder, pericholecystic fluid, and gallbladder adhesions. Conclusions: Operative difficulty of laparoscopic cholecystectomy can be predicted with careful preoperative assessment.
  Cholecystectomy; Laparoscopic cholecystectomy; Prediction of difficulty; Conversion  

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