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Volume 6, Issue 8(Suppl) J Gastrointest Dig Syst 2016
ISSN:2161-069X JGDS, an open access journal
Page 42
Notes:
Digestive Diseases 2016
December 08-09, 2016
conferenceseries.com
Digestive Diseases
December 08-09, 2016 Dubai, UAE
International Conference on
Predictors of difficult laparoscopic cholecystectomy
Nagendra Prasad
Maxcure Hospitals, India
Laparoscopic cholecystectomy is one of the most commonly performed laparoscopic surgeries worldwide. The spectrum of the
disease ranges from simple symptomatic cholelithiasis with minimal edema, adhesions in calots triangle, ruptured and gangrenous
gallbladder with dense adhesions involving stomach, transverse colon and anterior abdominal wall to Mirrizzi Syndrome. There is no
uniform consensus as to predictors of preoperative difficult GB and conversion to open cholecystectomy. Few indicators have been
proposed but they are not applicable in all the cases leaving a room for intra-operative surprises. Few of the preoperative indicators
established from various studies in literature are thickened gall bladder wall (> 4 mm), presence of palpable tender mass and raised
TLC along with deranged LFT in my experience of more than 400 cases, few other indicators as predictors of preoperative difficulty
and possible conversion to open cholecystectomy have been noticed. Male gender, multiple attacks and increasing periodicity of
attacks, presence of cholangitis and gall stone pancreatitis, post ERCP, presence of elevated liver enzymes, initial severe first attack
and palpable tender mass are predictors on history and examination. Raised temperature >100 F; elevated TLC>10000; altered
LFT, pericholecytic fluid and free fluid in Morrison’s pouch (however minimal), contracted GB, cirrhotic liver, impacted stone at
Hatmann’s pouch are suggestive of difficult laparoscopic cholecystectomy. A previous surgery only increases the difficulty for entering
abdomen but actually does not mean difficult GB dissection. All said and done, even in the absence of above findings, one might
encounter difficult gall bladder dissection, hence every case has to be treated on its individual merit and one should always be ready
for a difficult dissection.
Biography
Nagendra Prasad is a Consultant GI Surgeon and Advanced Laparoscopic Surgeon heading the Department of Laparoscopic and GI Surgery at Maxcure Hospitals,
Hyderabad, India. He has vast experience of more than 10 years in the field of GI surgery and laparoscopy. He is well versed with many advanced techniques in laparoscopy
and is expertise in minimally invasive upper GI surgeries.
Nagendra Prasad, J Gastrointest Dig Syst 2016, 6:8(Suppl)