الفهرس 
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Abstract
The aim of the present study was to evaluate a scoring method to predict difficult Laparoscopic cholecystectomy preoperatively and decrease complication of Laparoscopic cholecystectomy.
This was Observational cohort study, was carried out at General Surgery Department at Assiut University Hospitals on 50 patients with chronic calculous cholecystitis. All patients of elective Laparoscopic cholecystectomy were subjected to scoring parameters one-day prior to surgery on admission. All the intraoperative events were recorded. The entire cases received standard postoperative care and follow up.
The main results of the study revealed that:
A total of 50 patients were involved in the study. Most of the patients 32 (64%) were aged below 50 years, with a female preponderance 38 (76%). Of the 50 patients, 5 (10%) had BMI ≤ 25kg/m2, 24 (48%) had BMI 25.1–27.5kg/m2and 21(42%) had BMI > 27.5 kg/m2.
According to the difficulty score; 80% of the patients were with easy score, 14% were with difficult score and 6% were with very difficult score.
There was highly significant difference between both Easy LC, Difficult and very Difficult LC groups as regards age, gender, and History of hospitalization (p <0.001).
There was highly significant difference between both Easy LC, Difficult and very Difficult LC groups as regards BMI, Abdominal Scar, and Palpable gall bladder (p <0.001).
There was highly significant difference between both Easy LC, Difficult and very Difficult LC groups as regards thick wall GB, Pericholecystic collection and Impacted stone (p <0.001).
There was highly significant difference between both Easy LC, Difficult and very Difficult LC groups as regards Operation time (p <0.001).
There was a significant correlation between pre-operative score and outcome of the LC.
Using a cutoff value of 5, preoperative Difficulty scoring had sensitivity and specificity of 84.2 and 96.1%, respectively, with an accuracy of 99.1% to predict difficulty of LC
The most important variable to predict difficult LC was the presence of pericholecystic collection (odds ratio (OR), 48.27), followed by the impacted stone at GB neck (OR, 33.47) and then the presence of Previous Acute Cholecystitis (OR, 10.47), then BMI> 27 kg/m2 (OR, 7.84) followed by the presence of Palpable Gall Bladder (OR, 7.17).