Analysis of Causes of Difficult Laparoscopic Cholecystectomy - A Retrospective Study

Background: Commonly performed and gold standard surgical procedure for the treatment of gall stones is laparoscopic cholecystectomy. Laparoscopic cholecystectomy is associated with low incidence of morbidity and mortality. But surgeons have encountered difficulties while doing laparoscopic cholecystectomy. Prediction of risk factors is needed to assess the intraoperative difficulties. Methodology: Patients who underwent laparoscopic cholecystectomy for cholelithiasis in Coimbatore medical college and hospital was retrospectively analysed and grouped into easy and difficult cases based on time taken for surgery, bile or stone spillage, injury to cystic duct or cystic artery, conversion to laparoscopic cholecystectomy. parameters like gallbladder wall thickness, presence of pericholecystic fluid collection, fibrosed gall bladder and adhesions in calots triangle were compared and statistical analysis done. Results: Thickened gall bladder wall, presence of pericholecystic fluid, fibrosed gall bladder and adhesions in calots triangle were found to be statistically significant predicting difficult laparoscopic cholecystectomy. Conclusion: Eventhough Laparoscopic cholecystectomy is one of the commonly performed surgical procedure. It should not be underestimated since vascular and biliary duct injuries associated with it increases the morbidity and care costs, and often lead to litigations. Therefore, identifying risk factors for difficult laparoscopic cholecystectomy is important to avoid these dreadful complications.