65.02 Predicting The Difficulty Of Elective Laparoscopic Cholecystectomy – A Novel Scoring System

Posted on January 26, 2017

N. M. Hanna1, E. A. Villatoro1  1King’s Mill Hospital,General Surgery,Mansfield, NOTTINGHAMSHIRE, United Kingdom

Introduction:
Laparoscopic cholecystectomy is one of the most commonly performed operations by general surgeons, both trainees and consultants. Unfortunately, they all come in various shapes and sizes. The aim of this study is to create a scoring system to predict the difficulty of elective laparoscopic cholecystectomy.

Methods:
One consultant general surgeon’s laparoscopic cholecystectomies between May 2015 and May 2016 (101 patients) were evaluated using a scoring system that included gender, CRP on index admission, gall bladder wall thickness, BMI, previous abdominal surgery, and previous severe acute pancreatitis. Basic patient demographics, length of operation, conversion to open, subtotal cholecystectomy, drain insertion, and length of stay were obtained. 

Results:
82 patients were identified retrospectively and organised into three categories depending on the score (0-4, 5-9, and 10-22). Category 1 (n=53, mean age 46.9) had a mean operation time of 77.6 minutes, a 1.9% conversion rate, a 9.4% likelihood of becoming a subtotal cholecystectomy, an 11.3% chance of having a drain, and a mean length of stay of 0.45 days. Category 2 (n=22, mean age 51.9) had a mean operation time of 93.9 minutes, a 4.5% conversion rate, a 31.8% likelihood of becoming a subtotal cholecystectomy, a 36.3% chance of having a drain, and a mean length of stay of 1.59 days. Category 3 (n=7, mean age 33.4) had a mean operation time of 100.1 minutes, a 0% conversion rate, a 28.6% likelihood of becoming a subtotal cholecystectomy, a 42.9% chance of having a drain, and a mean length of stay of 2.00 days.

Conclusion:
Our study demonstrates that we were able to accurately predict those patients who would have a longer operative time, a higher likelihood of conversion to open, and a longer post-operative hospital stay, which were considered surrogate markers for the difficulty of the procedure. This scoring system may be beneficial in the pre-operative setting.