Preoperative Evaluation of Difficulty on Laparoscopic Cholecystectomy

Takashi Hiromatsu, Hiroshi Hasegawa, Eiji Sakamoto, Shunichiro Komatsu, Kiyotaka Kawai, Tomotake Tabata, Seiji Natsume, Taro Aoba, Tomonori Tsuchiya and Naoki Matsumoto

Department of Surgery, Nagoya Daini Red Cross Hospital

Purpose: Laparoscopic cholecystectomy, although widely disseminated for treating benign gallbladder disease, involves complications such as biliary injury. This makes it very important to prevent complications. Materials and Methods: For the last 16 years, 1,926 patients of cholecystolithiasis underwent laparoscopic cholecystectomy with preoperative cholangiography (ERCP etc). We evaluated operating duration as an indicator of the degree of difficulty using multivariate logistic regression analysis. Results: We found that three factors-(gallbladder wall thickening, incarcerated stones in the gallbladder neck, and the duration of elevated CRP)-contributed most to extended operating time, showed as a linear function, Y=8.928×X+77.974. Risk was classified preoperatively into low, intermediate, and high. Anticipated operating time was 76 minutes in the low-risk group, 96 minutes in the intermediate-risk group, and 132 minutes in the high-risk group respectively. Conclusions: We concluded that we could select appropriate surgeon based on risk degree to decrease operative complications.

Key words
laparoscopic cholecystectomy, preoperative evaluation of difficulty, risk score

Reprint requests
Takashi Hiromatsu Department of Surgery, Nagoya Daini Red Cross Hospital
2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650 JAPAN

Accepted
January 31, 2007

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