Assessment of Pre-Operative Scoring Strategy for Prediction of Difficult Laparoscopic Cholecystectomy

Objective: To determine the sensitivity, specificity and diagnostic accuracy of pre-operative scoring in predicting a difficult laparoscopic cholecystectomy. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of General Surgery, Combined Military Hospital, Rawalpindi Pakistan, from Feb 2022 to Mar 2023. Methodology: This study was conducted on 153 patients undergoing laparoscopic cholecystectomy. All patients aged between 18 and 60 years who were planned to undergo laparoscopic cholecystectomy for symptomatic gallstones or gallbladder disease, were included. Patients who were pregnant, or were suffering from choledocholithiasis, gallbladder cancer, coagulopathy, or liver cirrhosis were excluded. Participants underwent pre-operative assessment for prediction of difficult surgery via the Randhawa scoring system and a score of 6 or greater indicating a difficult surgery. Subsequently, all patients went to surgery which was said to be difficult if the total surgical time was greater than sixty minutes, there was bile/stone spillage, injury to duct or artery occurred or there was a requirement for conversion to open cholecystectomy. Results: Our patients had a mean age of 44.18±4.83 years, of whom 91(59.5%) were female. Randhawa score at a cut-off of ≥6 as a predictor for the occurrence of a laparoscopic cholecystectomy had a sensitivity of 89.52%, a specificity of 93.10% and a diagnostic accuracy of 90.20%. Conclusion: Randhawa score carries good diagnostic accuracy in predicting the occurrence of a difficult laparoscopic cholecystectomy in the Pakistani population.