Prediction of intraoperative surgical difficulty during laparoscopic cholecystectomy using drip infusion cholangiography with computed tomography

Abstract Background Although findings from drip infusion cholangiography with computed tomography (DIC‐CT) are useful in preoperative anatomic evaluation for laparoscopic cholecystectomy (LC), their relationship with intraoperative surgical difficulty based on the difficulty score (DS) proposed by Tokyo Guidelines 2018 is unclear. We examined this relationship. Methods Data were collected from 202 patients who underwent LC for benign gallbladder (GB) disease with preoperative DIC‐CT in our department. DIC‐CT findings were classified into GB‐positive and GB‐negative groups based on GB opacification, and clinical characteristics were compared. DS assessed only on findings from around Calot's triangle was considered “cDS”, and patients were divided into cDS ≤2 and ≥3 groups. Preoperative data including DIC‐CT findings were evaluated using multivariate analysis. Results DIC‐CT findings showed 151 (74.8%) GB‐positive and 51 (25.2%) GB‐negative patients. Surgical outcomes were significantly better in the GB‐positive versus GB‐negative group for operation time (107 vs. 154 min, p < .001), blood loss (8 vs. 25 mL, p < .001), cDS (0.8 vs. 2.2, p < .001), and critical view of safety score (4.0 vs. 3.1, p < .001). cDS was ≤2 in 174 (86.1%) and ≥3 in 28 (13.9%) patients. By multivariate analysis, DIC‐CT findings and alkaline phosphatase values were independent factors predicting intraoperative difficulty. Conclusion DIC‐CT findings are useful for predicting cDS in LC.