A Scoring System to Predict Difficult Laparoscopic Cholecystectomy: A Five-Year Cross-Sectional Study

Background. Laparoscopic cholecystectomy since long time already has become the preferred method because laparoscopic cholecystectomy has many advantages compared to standard open cholecystectomy. However, since it has associated with a higher risk of complication, preoperative prediction of risk factors is needed to assess the intraoperative difficulties. Various scoring systems have a role in predicting intraoperative difficulties; however, there is a need to find a consistent and reliable predictive system. Aim. To validate a preoperative scoring system that will predict difficult laparoscopic cholecystectomy. Design of the Study. Nonrandomized retrospective descriptive study. Setting. Department of General Surgery, Lambung Mangkurat Univeristy Ulin Referral Hospital, Banjarmasin, Kalimantan Selatan, Indonesia. Methodology. A preoperative score was given to all the patients (134 patients from January 2015-December 2020) based on history, clinical examination, and sonographic findings. Using ROC curve, the cutoff for easy-difficult was 3.5 and difficult-very difficult was 7.5. The scores were compared in each patient to conclude the practicality of the preoperative predictive score. SPSS version 25 was used to analyze the data. Results. History of hospitalization for acute cholecystitis (p <= 0.001), high BMI (p=0.002), abdominal scar (p=0.005), palpable gallbladder (p <= 0.001), thick gallbladder wall (p <= 0.001), and leucocyte (p <= 0.001) were considered as the significant factors that predict difficult laparoscopic cholecystectomy. Sensitivity and specificity for easy-difficult cutoff of the scoring method were 72.6% and 87.5%, respectively, with the area under the ROC curve being 0.849. Sensitivity and specificity for difficult-very difficult cutoff of the scoring method were 70.0% and 84.5%, respectively, with the area under the ROC curve being 0.779. Conclusion. The preoperative scoring system evaluated in the study is reliable and beneficial in predicting the difficulty of laparoscopic cholecystectomy. However, further randomized prospective multicentric studies with large sample sizes are required to validate the efficiency of the scoring system.