PREOPERATIVE ASSESSMENT OF SCORING SYSTEM DESIGNED FOR PREDICTION OF DIFFICULT CHOLECYSTECTOMY IN PATIENTS WITH SYMPTOMATIC GALL STONES
Keywords:Difficult cholecystectomy, Laparoscopic cholecystectomy, Preoperative scoring system
Objective: To carry out preoperative assessment of scoring system designed for prediction of difficult cholecystectomy in patients with symptomatic gall stones.
Study Design: Prospective observational study.
Place and Duration of Study: The study was conducted in General Surgery Unit 1, ward 3, JPMC, from Jun 2017 to Aug 2018.
Methodology: During the study, 208 patients were enrolled who presented for the elective cholecystectomy. Personal data, comorbid illness, sonographic, clinical and biochemical parameters were assessed. Based on the preoperative scoring, outcome measure was easy, difficult or very difficult cholecystectomy.
Results: On the basis of preoperative assessment and scoring, 157 (75.5%) patients were preoperatively predicted for easy cholecystectomy whereas 51 (24.5%) patients were predicted for difficult cholecystectomy. Sensitivity and specificity of this scoring method were 96.5% and 68.5% respectively. Positive predictive value of this scoring method was 89.1% and 72.5% for easy and difficult cases, respectively.
Conclusion: The scoring system proposed in our study incorporating all the known factors for difficult cholecystectomy does provide a definite, objective and reliable prediction of difficult case pre operatively.