A prospective study on clinico-radiological factors predicting difficult laparoscopic cholecystectomy in our institute

IP Journal of Surgery and Allied Sciences, Journal Year: 2025, Volume and Issue: 6(4), P. 114 - 120

Published: Jan. 15, 2025

To assess clinical and radiological factors that predict difficult laparoscopic cholecystectomy. Laparoscopic cholecystectomy is a complex surgical procedure involving anatomical variations, adhesions, gall bladder contracting. Preoperative assessment crucial for identifying risks improving post-operative outcomes. The study identifies clinico-radiological predicting cholecystectomy, preoperative planning, reducing conversion rates, optimizing preparedness patient counseling safer, more efficient practices. A prospective observational was conducted at the Department of General Surgery, Integral Institute Medical Sciences Research in Lucknow, 90 patients selected Elective Cholecystectomy those with ultrasonographic ally proven cholelithiasis, excluding significant co-morbid illnesses or not fit pneumoperitoneum creation. utilized IBM SPSS Stats 25.0 software data analysis, presenting continuous as mean±standard deviation categorical/qualitative numbers percentages. Total aged 15-70, majority female (77.8%), mean BMI 18.5-30.0 kg/m2, 48 under 25 kg/m2. pre-operative scoring system developed using demographic, clinical, laboratory, USG findings. ranged from 0-5 to 11-15 surgeries, predictive score 0-7. Most surgeries were predicted easy, followed by (18.9%) very (5.6%). Factors like age, BMI, hospitalization history, comorbidities, abdominal scars associated ease surgery. assessed 15-70 procedures difficulty system, sex, BMI.

Language: Английский

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Neutrophil percentage-to-albumin ratio as a predictor of conservative treatment failure in acute cholecystitis: a retrospective cohort study

BMC Surgery, Journal Year: 2025, Volume and Issue: 25(1)

Published: Feb. 28, 2025

While early laparoscopic cholecystectomy is the standard treatment for acute cholecystitis, conservative management remains necessary in specific scenarios such as high-risk patients or resource-limited settings. This study evaluated predictive value of neutrophil percentage-to-albumin ratio (NPAR), a biomarker derived from routine laboratory tests, alongside established inflammatory markers and clinical parameters identifying at risk failure. In this retrospective cohort 2 tertiary centers (2020–2023), we analyzed 508 with cholecystitis who received management. The period coincided COVID-19 pandemic when healthcare resource constraints led to increased utilization Using admission data, calculated NPAR, neutrophil-to-lymphocyte (NLR), platelet-to-lymphocyte (PLR), assessed Charlson Comorbidity Index (CCI) American Society Anesthesiologists Physical Status (ASA-PS) classification. Receiver operating characteristic analysis logistic regression were performed evaluate their value. Conservative failed 107 (21.1%). Risk assessment showed higher proportions CCI ≥ 6 (32.7% vs. 22.9%; P =.008) ASA-PS class III-IV (16.8% 8.0%; =.002) group. NPAR demonstrated superior performance (area under curve, 0.906 [95% CI, 0.867–0.944]) compared NLR (0.810 [0.765–0.855]) PLR (0.614 [0.554–0.673]). optimal cutoff 21.5 sensitivity 88.8% specificity 84.8%. multivariable analysis, > emerged strongest independent predictor (adjusted odds ratio, 19.876 8.934–42.651]; <.001), followed by fever 37.8 °C (2.845 [1.476–5.483]; leukocytosis (2.234 [1.112–4.485]; =.024). Most failures (77.6%) occurred within 48 h, requiring emergency surgery (57.9%), percutaneous drainage (37.4%), endoscopic interventions (4.7%). combined leukocytosis, provides practical cost-effective framework predicting failure using tests. Although our was conducted during pandemic, these findings remain valuable any setting where considered. 48-hour window most timeframe monitoring intervention decisions.

Language: Английский

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Defining preoperative predictors of difficult laparoscopic cholecystectomy in children

Journal of Pediatric Endoscopic Surgery, Journal Year: 2025, Volume and Issue: unknown

Published: March 7, 2025

Language: Английский

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Robotic versus laparoscopic cholecystectomy for difficult gallbladders: an observational study of tertiary centre cases

Surgical Endoscopy, Journal Year: 2025, Volume and Issue: unknown

Published: March 20, 2025

Abstract Background Although laparoscopic cholecystectomy (LC) is considered a low-risk procedure, intraoperative bleeding, bile duct injury and leak occur frequently in the ‘difficult’ gallbladder. Robotic (RC) can overcome difficulties related to poor vision instrumentation difficult cases avoid complications conversion open surgery. The aim of study was evaluate outcomes robotic patients with gallbladders referred tertiary HPB centre. Methods We conducted retrospective review all senior hepatobiliary pancreatic surgeon gallbladder between December 2013 March 2024. Primary were 30-day post-operative complications. Results A total 88 ( n = 35 laparoscopic, 53 robotic) centre during period, consisting 21.7% cholecystectomies 404). complication rate (14.3% vs 3.8%, OR 4.25, 95% CI 0.77–23.28, p 0.0951) (8.6% 0.0%, 11.52, 0.57–230.32, 0.109) both higher group, but these differences not statistically significant. median operative time significantly group (108.5 min 50.0 min, 0.001). Conclusions Both are viable approaches cases, being associated potentially fewer conversions Pre-operative referral intra-operative abandonment be safe exit strategies for cases.

Language: Английский

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Development and validation of a radiologically-based nomogram for preoperative prediction of difficult laparoscopic cholecystectomy

Frontiers in Medicine, Journal Year: 2025, Volume and Issue: 12

Published: April 22, 2025

Background Preoperative prediction of difficult laparoscopic cholecystectomy (DLC) remains challenging, as intraoperative anatomical complexity significantly increases complication risks. Current studies have not reached consensus on definitive risk factors for DLC. Materials and methods This retrospective study aimed to identify DLC develop a predictive model. We analyzed clinical data from 265 patients undergoing (LC) at the Department General Surgery, Shijiazhuang People’s Hospital, between September 2022 June 2024. Risk were explored through least absolute shrinkage selection operator (LASSO) regression, multivariate analysis, receiver operating characteristic (ROC) curves, with nomogram constructed prediction. Results Among eligible patients, four independent identified: thickness gallbladder wall ( p = 0.0007), cystic duct length &lt; 0.0001), diameter neck stones 0.0002). The demonstrated strong performance, an area under curve (AUC) 0.915 in training cohort 0.842 validation cohort. Calibration curves indicated excellent model fit. Conclusion discussion proposed integrating stones, wall, length, may assist surgeons preoperative stratification. Further multicenter prospective is warranted.

Language: Английский

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Redefining acute acalculous cholecystitis: insights into its systemic inflammatory implications

Gastroenterology & Hepatology Open Access, Journal Year: 2024, Volume and Issue: 15(3), P. 51 - 52

Published: May 28, 2024

Over the last three years, we have observed a consistent finding in individuals who did not gallstone disease, with clinical pictures of: "evaluate for RUQ pain," bile duct dyskinesia," or similar.The was that these subjects all had circumferential inflammatory changes of proximal duodenum, alone combination extension to and asymmetric involvement gallbladder (greater inflammation adjacent duodenum).This especially noticeable when organs abutted one another (Figure 1).][11][12][13][14][15] Prior reporting has suggested non-negligible number cases, regional may be triggering factor acute cholecystitis. 11

Language: Английский

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