Published: 2022-10-29

Validation of intra-operative scoring system for difficult laparoscopic cholecystectomy

Saumya Gupta, Krishnanand Anand, Palak Paliwal, Aditya S. Baghel


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.


Laparoscopic cholecystectomy, Intraoperative scoring, Gallbladder, Gallstones, Difficult LC

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