Slovenská chirurgia 1/2012
Predictive value of selected demographic and anamnestic parameters to assess difficulty of elective laparoscopic
Aims: To analyze selected demographic and anamnestic parameters as potential risk factors increasing difficulty of elective laparoscopic cholecystectomy (LC). Material and methods: Unicentric clinical cohort study – consecutive prospective serie of elective LCs during 3-years period was investigated. Data on operating time (OT), conversion, surgeon’s subjective evaluation (SSE) score and presence of selected risk factors (age over 65, male sex, history of biliary colic within last 3 weeks prior surgery, previous abdominal surgery above level of umbilicus, history of acute cholecystitis) was recorded. Subgroups with positivity of particular risk factors were compared to the rest of the serie to detect significant differences (p<0.05). Results: 586 LCs were investigated. Positivity of analyzed risk factors was noted as follows: age over 65 – 68, male sex – 156, history of biliary colic within last 3 weeks prior surgery – 77, previous abdominal surgery above level of umbilicus – 6, history of acute cholecystitis – 85 patients. Positivity of any of investigated risk factors was associated with significantly prolonged OT and increased SSE score (p<0.001). Conversion rate was significantly higher in subgroups with history of acute cholecystitis (p<0.001) and biliary colic within last 3 weeks prior surgery (p<0.01), as well as in patients over 65 (p<0.001). Conclusions: Selected demographic (age over 65, male sex) and anamnestic parameters (history of biliary colic within last 3 weeks prior surgery, previous abdominal surgery above level of umbilicus, history of conservatively treated acute cholecystitis) are associated with increased difficulty of elective LC both in subjective (SSE score) and objective (OT) arm of assessment. Universal availability of data on described risk factors further improve their potential to become routinely evaluated in order to assess difficulty of elective LC preoperatively.
Keywords: laparoscopy, laparoscopic cholecystectomy, difficulty, conversion, risk factors.
