| Abstrakt: |
Background: Cholelithiasis is one of the most common problems affecting the digestive tract. Laparoscopic cholecystectomy (LC) is the gold standard treatment for symptomatic cholelithiasis. This procedure though mostly safe and uneventful can be difficult at times. A lot of problems can be avoided by correct preoperative prediction of difficult cholecystectomy. Many studies have attempted to create a scoring system to predict difficulty in LC. One such scoring system was devised by Randhawa and Pujahari. Objective: The aim of our study was to ascertain the validity of this scoring system in our hospital scenario. Materials and methods: This was a prospective study conducted at District Hospital Anantnag, a rural healthcare center located in the valley of Kashmir, India, from September 2016 to September 2018. Out of 327 patients admitted for LC were enrolled. Each patient was assigned scores preoperatively based on the history, clinical assessment, and sonographic findings as described by Randhawa and Pujahari. All intraoperative events like duration of surgery, bile stone spillage, and injury to duct/artery were recorded. Postoperatively, we defined the surgical procedure as easy, difficult, and very difficult as described by Randhawa and Pujahari. Results: The mean age of patients in our study was 43 years. In our study, we observed that age >50 years, male sex, body mass index (BMI) >27.5, history of hospitalization for acute cholecystitis, palpable gallbladder on clinical examination, and thick wall gallbladder on sonography were statistically significant predictors of difficult LC. The sensitivity, specificity, positive predictive value and negative predictive value of this scoring system as reported by us are 86.41, 79.76, 92.51, and 67%. Conclusion: We conclude that the scoring system of Randhawa and Pujahari for the prediction of the difficulty of LC applies to rural settings and has high sensitivity, specificity, and accuracy. [ABSTRACT FROM AUTHOR] |
