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Article Type

Article

Abstract

Background: The identification of the difficult laparoscopic cholecystectomy (LC) is important for operative planning, patient counselling, and minimizing intra-operative complications. Abdominal ultrasonography is a routine part of the preoperative evaluation, but may not identify biliary anatomic variations or undetected ductal disease. When used as part of a structured preoperative scoring system, magnetic resonance cholangiopancreatography (MRCP) may prove to be more helpful in predicting the outcome.
Objective: To determine if the addition of MRCP findings to a modified preoperative score for laparoscopic cholecystectomy (LC) will improve prediction of the difficulty of the procedure.
Methods: In this prospective observational study, 86 patients were selected, who were scheduled to undergo laparoscopic cholecystectomy surgery at Imam Al Sadiq Teaching Hospital and private hospitals in the city of Babylon, Iraq, from April 2023 to May 2025. The patient was evaluated with an existing preoperative score of 15 points, based on demographic, clinical and ultrasonographic data. The findings of MRCP were then added in to generate a modified 19 point score. Operating surgeon rating of the difficulty during the operation was divided into easy, difficult, and very difficult categories, and the diagnostic performance of both systems was compared by calculating sensitivity, specificity, predictive values, accuracy, and the area under the receiver operating characteristic curve (AUC).
Results: Mean age of the patients was 47.6 ± 13.2 years and 76.7% were female. Three quarters of the patients had gallbladder wall thickening, pericholecystic collection (25.6%) and impacted stones (23.3%) and MRCP was able to show other biliary abnormalities in a small but clinically relevant group. Under the original 15 point score, 52.3% of cases were considered easy, 36.1% difficult and 11.6% very difficult, while the modified 19 point score classified 37.2%, 45.3% and 17.5% of cases respectively. Intraoperatively, 38.4% of procedures were straight forward, 46.5% were difficult and 15.1% were very difficult. The 15 point score gave an AUC of 0.82 and achieved a 77.0% accuracy; the 19 point score gave an AUC of 0.91 and achieved a 87.2% accuracy.
Conclusion: The use of MRCP in a modified pre-operative scoring system would improve the ability to predict difficult laparoscopic cholecystectomy, and would be closer to the intraoperative results than the original clinical-ultrasound score. The MRCP-enhanced model might aid in surgical planning and risk stratification.

Keywords

Laparoscopic cholecystectomy, Pre-operative scoring, Magnetic resonance cholangiopancreatography (MRCP), Predictive model/ROC analysis

Creative Commons License

Creative Commons Attribution 4.0 International License
This work is licensed under a Creative Commons Attribution 4.0 International License.

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