Prediction of Difficulty Level of Laparoscopic Cholecystectomy According to Preoperative Findings.

Objective: Laparoscopic cholecystectomy stands as the established surgical approach for gallbladder diseases. This study seeks to enhance the management of potential complications by anticipating the likelihood of operative complexity and the risk of requiring conversion to an open procedure. Methods: In this retrospective study, a total of 811 cholecystectomy procedures were undertaken, segregating patients into case and control groups. The case group comprised 24 patients who initiated laparoscopically but ultimately underwent open conversion. Exclusion criteria encompassed direct open procedures, patients below 18 years of age, and cholecystectomies performed concurrently with other surgeries. A control group of 276 patients was chosen, matched for age, gender, and body mass index, to evaluate the influential aspects governing conversion likelihood. Results: The study demonstrated a conversion rate of 3.09%. The preeminent determinant of conversion was the increased gallbladder wall thickness. Factors exerting influence on conversion included a history of endoscopic retrograde cholangiopancreatography, prior abdominal surgery, elevated C-reactive protein, lactate dehydrogenase, and direct bilirubin levels, instances of cholecystitis and cholangitis attacks, dense adhesions between the gallbladder and close organs, gallbladder hydrops, impacted stones, and a Callot dissection time exceeding 90 minutes. The Sugrue scoring system was also observed as a potentially valuable tool for predicting the likelihood of open conversion. Conclusion: The capacity to foresee potential complications proactively empowers optimal preoperative preparations. This approach ensures patients are well-informed about the surgery, potential complications, and the prospect of conversion to an open procedure. Moreover, it enables the possibility of conducting the operation within a more experienced medical center when warranted. [ABSTRACT FROM AUTHOR]