Abstract

     Preoperative scoring system to predict difficult laparoscopic cholecystectomy can be regarded as an instrument in the hand of the surgeon, which could help him to prepare for difficult operation, make better preoperative counseling of the patient, and in general, it is a further step towards the safe, modern, surgical practice. The study aimed developing a simple scoring system to predict difficult laparoscopic cholecystectomy preoperatively, which can be used in the daily clinical practice.
     This is a retrospective study carried out in the 22 May Hospital, Aden, from 1st March 2018 to 29th February 2020. It included 405 patients who had laparoscopic cholecystectomy, and among them, 137 had difficult operation. 10 variables were subjected for multivariate study (binary logistic regression) which had shown association with difficult laparoscopic cholecystectomy on previous univariate analysis. Statistical software SPSS version 17 was used for this purpose and significance level was set to p< 0.05. The necessary predictors (independent factors) which were able to explain the outcome (difficult laparoscopic cholecystectomy) were identified with statistical significance. The effect size of these predictors was rounded and the new values were adopted as scores for each factor. A scoring system was constructed from these factors and their scores. The accuracy of the new score system was tested by the ROC analysis against the same sample.
7 predictors were identified. Depending on these variables, the prediction for easy laparoscopic cholecystectomy came true in 87% of cases and the prediction for difficult laparoscopic cholecystectomy came true in 85% of the cases.  The returned area under the curve was 0.913, with 95% confidence interval. A score above 2.25 was considered difficult with sensitivity and specificity of 82.25% and 85.8% respectively.  There were no cases with score above 9.
     From the findings of the current study, it could be concluded that the new scoring system had good predictive capability to difficult laparoscopic cholecystectomy and it incorporates simple, few determinants, which could help surgeon and improve patient curative care.