P. Schrenk et al., A DIAGNOSTIC SCORE TO PREDICT THE DIFFICULTY OF A LAPAROSCOPIC CHOLECYSTECTOMY FROM PREOPERATIVE VARIABLES, Surgical endoscopy, 12(2), 1998, pp. 148-150
Background: Modified logistic regression analysis of 24 variables in 3
00 patients undergoing laparoscopic cholecystectomy found the followin
g parameters independently predictive for a difficult operation: right
upper quadrant pain (p < 0.01), rigidity in right upper abdomen (p <
0.01), previous upper abdominal surgery (p < 0.01), biliary colic with
in the last 3 weeks (p < 0.05), white blood cell count > 10 x 10(9)/l
(p < 0.05), thickening of the gallbladder wall (p < 0.05), hydroptic g
allbladder (p < 0.05), pericholecystic fluid (p < 0.01), shrunken gall
bladder (p < 0.01), and no filling of the gallbladder in preoperative
intravenous cholangiography (p < 0.05). Methods: Based on these variab
les a diagnostic model was developed to predict the difficulty of a la
paroscopic cholecystectomy, with scores ranging from 0 (ideal case) to
IV (conversion to open cholecystectomy expected) prior to surgery. Re
sults: When the reliability of our model was examined in a second stud
y in 340 consecutive patients undergoing laparoscopic cholecystectomy
80% of the patients were predicted correctly. Conclusions: Our model s
hould help to select patients for either laparoscopic or open cholecys
tectomy based on the expected difficulties and the experience of the s
urgeon.