Evaluation Of Clinico-Radiological Factors Predicting Difficult Laparoscopic Cholecystectomy
Authors/Creators
Description
Background: Laparoscopic cholecystectomy (LC) is the gold standard for symptomatic gallstone disease. However, a subset of cases remains technically difficult, increasing the risk of complications and conversion to open surgery.
Aim: To evaluate clinico-radiological and laboratory factors predicting difficult LC.
Methods: A prospective observational study was conducted on 120 patients undergoing LC at the Integral Institute of Medical Sciences, Lucknow (Jan 2024–Mar 2025). Clinical, laboratory, and ultrasonographic parameters were recorded. Intraoperative difficulty was graded as easy, difficult, or very difficult. Statistical correlation was analyzed.
Results: Mean patient age was 44.2 ± 11.8 years; females comprised 70%. Difficult and very difficult LC were encountered in 28.3% and 11.7% cases, respectively, with a conversion rate of 6.7%. Significant predictors of difficult LC were BMI ≥ 25 kg/m² (p=0.001), recurrent cholecystitis, raised total leukocyte count (p=0.001), gallbladder wall thickness >3 mm (p<0.001), impacted neck stone (p=0.04), and pericholecystic fluid (p=0.03).
Conclusion: Obesity, recurrent cholecystitis, inflammatory markers, and specific ultrasonographic features are reliable predictors of difficult LC. Incorporating these factors into preoperative assessment can improve risk stratification, surgical planning, and patient outcomes.