OPERATIVE DIFFICULTIES IN LAPAROSCOPIC CHOLECYSTECTOMY–SCORING SYSTEM

Background: The laparoscopic cholecystectomy is the golden standard for many surgeons nowadays. Many intra-operative difficulties occurred during laparoscopic cholecystectomy that urging surgeons to develop scoring system predicting these difficulties. Aim of study: To establish the best scoring system based on intra operative parameters to predict the difficulty of laparoscopic cholecystectomy. Patients and methods: This study is a prospective follow up study carried out in Surgical Ward of Baghdad Teaching Hospital during the period from 1st of October, 2016 to 31st of September, 2017 on convenient sample of 80 patients with chronic symptomatic cholelithiasis. The intra-operative characteristics were recorded by the researcher during the procedure of laparoscopic cholecystectomy. Results: The difficulty criteria of laparoscopic cholecystectomy in studied patients were based on operation time, bile or stone spillage and conversion to open surgery. Significant risk factors for difficulty were obesity, pre-operate surgery, complete gall bladder adhesions, distended gall bladder, inability to grasp, impacted stones, peri-colic collections and prolonged time of Calots' triangle dissection. Conclusions: The intra-operative difficulty scoring of Laparoscopic cholecystectomy is cornerstone in laparoscopy technique.