Prediction of difficult laparoscopic cholecystectomy as the principle of improvement of the results of surgery (review)

At present, laparoscopic cholecystectomy (LC) has become the «gold standard» of acute and chronic cholecystitis treatment and one of the frequent operations performed in general surgery. All these complications characterized LC as difficult, however, there is no consensus regarding the definition of the difficulty of LC. The aim of this review is to find a consistent and reliable system for predicting intraoperative complications to improve outcomes of LC. Difficult LC (DLC) is defined as the surgical removal of the gallbladder in conditions when changes in the organ itself, adjacent structures, or the patient’s specific condition prevent its smooth, quick, and comfortable removal during surgery. The definition of DLC varies considerably depending on the experience of the surgical team. With the improvement of technique and skills of LC, the criteria of complexity of surgery and choice of «salvage procedure» have changed. Preoperative prediction of DLC is extremely important for the choice of adequate treatment and decreases the frequency of intra- and postoperative complications. Various preoperative factors, laboratory data, and results of imaging investigation methods, which are connected with cholecystitis, anatomical changes, previous abdominal surgery, surgeon experience, and comorbidities may determine unfavorable outcomes of surgical procedures. Multiple predictive systems (scales), which combine clinical, laboratory data, and imaging parameters were elaborated to improve the accuracy of preoperative identification of DLC, including elective and emergent surgical procedures, merged personal history-related factors with clinical and imaging factors. These models were more useful than considering each significant factor separately. Another important preoperative factor that determines the outcome of treatment is the stratification of patients in whom conversion is possible. Conclusions. Various international studies propose preoperative systems of value for solving the problem of DLC. At the same time, it is extremely important to develop a scale adapted to the characteristics of each population to optimize the efforts of surgeons and improve the overall quality of medical and surgical care. With the improvement skills of LC, the markers of difficulty of surgery change influenced on prognostic value of proposed models. The present prospective cohort studies with validated indicators of difficult surgery may suggest further identification of the best systems for predicting the severity of intervention to improve treatment outcomes. No conflict of interests was declared by the authors.