A DIAGNOSTIC SCORE TO PREDICT THE DIFFICULTY OF A LAPAROSCOPIC CHOLECYSTECTOMY FROM PREOPERATIVE VARIABLES

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.