الفهرس 
• Anatomical Background of GallbladderOnly 14 pages are availabe for public view
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Abstract
Background: The gallbladder is a small, pear-shaped organ that is part of the digestive system. It is located on the right side of the abdomen below your liver. The gallbladder stores and secretes bile, which is made by the liver, into the small intestine during digestion. Bile, a yellow-brownish fluid, helps digest fats in food, after meals, the gallbladder is empty and flat, like a deflated balloon. Before a meal, the gallbladder may be full of bile and about the size of a small pear.
Aim of the Work: To validate a risk score based on the patient’s history, physical examination and abdominal ultrasonography parameters for prediction of difficult laparoscopic cholecystectomy.
Patients and Methods: Our study included 30 patients underwent laparoscopic cholecystectomy in Ain Shams hospital and Alamria hospital. Males was more predominant than females (73.3% vs 26.7%) with mean age of (40.23 ± 13.64) years. Our patients had mean BMI of (28.43 ± 4.03) kg/m2 with most of them were obese (63.3%). Intra operative difficulty showed significant relation with sex and BMI.
Results: In our study, 13.3% of patients had leukocytosis and all our patients had normal alkaline phosphatase. 56.7% of the study patients were presented with previous acute attacks, 20% presented with fever, 6.7% had palpable GB and 33.3% had abdominal scar. Intra operative difficulty showed significant relation with previous acute attack, abdominal scar and GB wall thickness. We found that preoperative scoring had a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 84.6%, diagnostic accuracy of 93.3%, and Kappa agreement of 0.862 compared to the intraoperative scoring system.
Conclusion: We strongly recommend using the preoperative scoring system for predicting the degree of difficulty for laparoscopic cholecystectomy. In addition, it is also recommended to conduct more studies on the application of the intraoperative scoring system.
Keywords:
Common bile duct, Gall bladder, Cholecystokinin, Endoscopic ultrasound