Cholecystitis, Degree of difficulty, Laparoscopic cholecystectomy, Severity grading
Citation Information :
Surati K N, Modi R, Damani S, Prajapati K, Shah A, Patel M. Study of Difficult Laparoscopic Cholecystectomy and Its Outcome According to Preoperative Scoring System. World J Lap Surg 2022; 15 (1):11-13.
Aims: To study comparison of peroperative finding in difficult cholecystectomy with a scoring system, to evaluate the amount of complexity in the surgery and its outcome.
Materials and methods: A study of 50 patients undergoing elective difficult laparoscopic cholecystectomy was done. In difficult cholecystectomy, peroperative scoring was carried out, and based on these findings evaluation of the amount of complexity and results of the surgery was assessed according to the scoring system.
Results: Patients with chronic calculous cholecystitis were 16 and degree of difficulty had an average score of 5 while of acute calculous cholecystitis were 28 patients with an average score of 6 and mucocele of gall bladder were 3 cases with an average score of 7. Two cases of empyema gall bladder and one case of gangrenous gall bladder both with an average score of 8. All extreme difficulty cases with a score of 8 were converted to open. Increased severity of score is proportional to the increased complexity of the surgery. Conversion to open surgery is indicated in an extreme degree of difficulty with a score of 8.
Conclusion: This intraoperative scoring system is important in the evaluation of the complexity of cholecystectomy surgery and evaluating the amount of complexity in carrying out laparoscopic cholecystectomy.
Clinical significance: In mild, moderate, and severe degrees of difficult cholecystectomy according to the peroperative scoring system (5–7), can be completed laparoscopically without complication. In extreme level difficult cholecystectomy, peroperative scoring system (≥8) can guide us to make the decision to convert it into open surgery and also help in preventing life-threatening complications like bile duct injury.
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