Background: Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic gallstone disease.However, certain preoperative factors may predict technical difficulty, potentially increasing operative time,complication risk, and conversion to open cholecystectomy. This study aims to assess the role of preoperativeclinical and radiological parameters in anticipating intraoperative challenges.Objectives: To evaluate and correlate specific preoperative clinico-radiological findings with intraoperativedifficulty in laparoscopic cholecystectomy, thereby aiding in better surgical planning and patient counseling.Methods: A prospective observational study was conducted on 120 patients undergoing elective laparoscopiccholecystectomy at Department of General Surgery, Dr. Panjabrao Deshmukh Memorial Medical College,Amravati, Maharashtra, India. Preoperative clinical factors (age, BMI, history of acute cholecystitis, previousabdominal surgery, and palpable gallbladder) and radiological findings (gallbladder wall thickness,pericholecystic fluid, impacted stones, gallbladder contraction, and common bile duct diameter) weredocumented. Intraoperative difficulty was scored based on operative time, adhesions, bleeding, and need forconversion. Statistical analysis was performed to assess correlations.Results: Out of 120 patients, 38 (31.7%) experienced significant intraoperative difficulty. Older age (>60 years),BMI >30 kg/m², history of acute cholecystitis, and palpable gallbladder were significantly associated with difficultlaparoscopic cholecystectomy. On imaging, gallbladder wall thickness >3 mm, pericholecystic fluid, andcontracted gallbladder were strongly predictive of intraoperative difficulty (p<0.05). The conversion rate to opencholecystectomy was 8.3%.Conclusion: Preoperative clinical and ultrasonographic parameters provide valuable insight into predicting thecomplexity of laparoscopic cholecystectomy. Recognizing these factors preoperatively helps surgeons anticipatetechnical challenges, optimize team preparedness, and inform patients appropriately.
Tardeja et al. (Wed,) studied this question.