الفهرس 
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Abstract
For patients with chronic calcular cholecystitis, laparoscopic cholecystectomy is now considered the gold standard of care..
This study was carried out on sixty patients presented with symptoms of chronic calcular cholecystitis. The aim of this study is to determine the role of scoring system in predicting the difficulty of laparoscopic surgery in laparoscopic cholecystectomy.
All patients were subjected to through history taking, physical examination, laboratory investigations (complete blood picture, blood glucose level, prothrombin activity, aspartate transaminase, alanine transaminase, serum bilirubin level, alkaline phosphatase, viral hepatitis B&C, serum amylase and lipase), plain X-Ray chest and abdomen ultrasonography.
Patients’ age ranged between 18-59 years with mean±S.D. 38.78 ± 9.05. Patient’s sex showed that 43(71.7%) were females and 17(28.3%) were males. Number of hospitalized patients was 14(23.3%) and non-hospitalized patients 46(76.7%).
Every patient received a preoperative score based on their history, clinical examination, and sonographic findings and it has ranged between 1-11 with Mean ± SD. 4.28 ± 2.93 and the results were distributed as follows:
- 45(75%) patients their score was easy.
- 13(21.7%) patients their score was difficult.
- 2(3.3%) patients their score was very difficult.
According to intraoperative assessment of patients there were 38(63.33%) patients had less than 60 min. in surgery and 17(28.33%) patients had from 60-120 min. in surgery. While there were 5 patients had more than 120 min. in surgery. Bile spillage happened during surgery in 19(31.66%) patients while 41(68.33%) patients had no bile spillage. There was no duct injury during all the 60(100%) patients’ surgeries. Only 1(1.7%) patient has been converted to open cholecystectomy due to difficulties during surgery while the rest (59(98.3%) patients) completed with the laparoscope.
Intra operative grading showed that 36(60%) patients were easy, 19(31.66%0 patients were difficult and 5(8.33%) patients were very difficult.