Predictors of Difficult Laparoscopic Cholecystectomy, Scoring Systems, and Their Implications on the Outcomes Sohag Experiences .

Mahmoud, Mahmoud Fahmy; Mahmoud, Ahmed Gaber; Saleem, Abdel-aal Ali; Redwan, Alaa Ahmad

doi:10.21608/smj.2025.391351.1580

Predictors of Difficult Laparoscopic Cholecystectomy, Scoring Systems, and Their Implications on the Outcomes Sohag Experiences .

Document Type : Original Article

Authors

¹ general surgery department shag university sohag egypt

² general surgery sohag university

³ general surgery ,faculty of medicine ,sohag university

⁴ General Surgery Department, Faculty of Medicine, Sohag University, Sohag; Egypt

10.21608/smj.2025.391351.1580

Abstract

Abstract

Background: Although laparoscopic cholecystectomy (LC) has become the primary surgical treatment for cholelithiasis, certain patients still require conversion to open cholecystectomy.

sometimes caused by difficulties that need special techniques and tailored to the operator to avoid more complication. We are aiming at this work to predict difficult LC preoperatively, decrease complication of LC, tailored lap chole to the operator surgeon and decrease percentage of conversion and overall morbidity and mortality.

Methods: In this prospective study, 50 patients with symptoms of gallstone disease took part. All patients were subjected to Randhawa score and Nassar grading system.

Results: In multivariate regression, age, sex, body mass index, previous acute cholecystitis, wall thickness, abdominal scar (supra umbilical), impacted gallstone and pericholycystic collection were peculiar independent indicator of difficult LC (P value <0.05) while previous abdominal infraumbilical surgery was not predictor. Preoperative score of difficulty can significantly predict difficult LC (P <0.001 and area under the curve =0.984) at cut-off >5 with 87.5% sensitivity, 90.4% specificity, 63.6% positive predictive value and 97.4% negative predictive value.

Conclusions: Both scoring systems are effective in predicting the difficulty of LC. However, Nassar scoring system, which includes both preoperative and intraoperative assessments, is superior due to its simplicity, ease of application, and ability to gather useful preoperative data, also its applicability from first look intraoperatively, and it helped us during the study in predicting difficult cases from the first look.

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