Table 2 Predictors of difficult gallbladder [12]
From: The difficult laparoscopic cholecystectomy: a narrative review
History Male Age > 65 year) Prior AC, Interval between onset and presentation > 72–96 h in AC Previous multiple attacks of biliary pain (> 10) History of AC Upper abdominal surgery Prior attempt at cholecystectomy (including cholecystostomy) | |
Physical examination Fever Higher ASA score Morbid obesity | |
Laboratory tests Raised WBC count (> 18000/mm3) Raised CRP | |
Imaging (USG/CT/MRCP) Thick walled GB (> 4–5 mm) Small contracted GB Distended GB with a stone impacted in neck Gangrenous/perforated GB Mirizzi syndrome/Cholecystoenteric fistula Cirrhosis/portal cavernoma with portal hypertension | |
Intraoperative Small shrunken GB not visualized on initial exploration Liver edge puckering near fundus Fatty or cirrhotic liver (difficulty in retraction) |