Validation of intra-operative scoring system for difficult laparoscopic cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy is the procedure of choice for most patients with gallbladder disease. The key, as in open surgery, is the identification and safe dissection of Calot’s triangle. Surgeons performing laparoscopic cholecystectomy should not think of conversion to open operation as a complication, but rather a sound clinical judgment.Methods: This is an observational, single center study. The scoring system included five aspects; appearance and adhesion of gall bladder (GB), distension or contracture degree of GB, ease in access, local or septic complications, and time required for cystic artery and duct identification. A score of <2 would imply mild difficulty, 2–4 moderate, 5–7 severe and 8–10 extreme. The scores were compared in each patient to conclude the practicality of intra operative predictive score.Results: The most common reason for conversion to open surgery was found to be difficulties in dissection of cystic duct and artery in Calot’s triangle. The moderate and severe category was found to be statistically insignificant to predict the conversion, therefore, one can consider to merge these 2 categories into a single category to forfeit the prediction for conversion.Conclusions: The extreme category was found to be statistically significant for prediction of conversion, therefore, the patients falling into this category forfeits the chances of increased risk of injury and therefore, should be converted early.

The Nassar Scale as an Instrument for Predicting Conversionof Laparoscopic to Open Cholecystectomy

“…Using a prospective approach to analyse all grades on the Nassar scale, we sought to achieve consistent and reliable results, in order to investigate the practical application of this scale in our clinical practice. Gupta et al 9 defined surgeries as difficult if it took more than 60 minutes to complete the cholecystectomy, which is consistent with our findings, suggesting that the longer duration of surgery correlates with higher Nassar grades. Kemal et al 10 used the duration of the operation to classify the severity of cholecystectomy, dividing these operations into "difficult" and "very difficult" according to the duration of the cholecystectomy and complicating factors.…”

“…Emergency patients had significantly higher Nassar grades compared to patients undergoing elective surgery. While no studies comparing Nassar grade levels based on the type of surgical indication for cholecystectomy were found, previous research indicated a potential connection between complications during laparoscopic cholecystectomy and variations in C-reactive protein (CRP) levels, with notable discrepancies in CRP values and conversion criteria across different studies1 [1][2][3][4][5][6][7][8][9][10][11][12][13][14] . While our study did not specifically investigate the relationship between CRP levels and conversion, this aspect warrants attention in future research to understand better how CRP may be linked to the Nassar scale.…”