Laparoscopic cholecystectomy has become the gold-standard treatment for symptomatic cholelithiasis replacing open cholecystectomy. Surprisingly, it has variable outcomes and conversion rates. This single centre, prospective study uses the intra-operative scoring system, devised by Michael Sugrue et al to grade difficulty of laparoscopic cholecystectomy intraoperatively. This score has also been used to predict conversion rates.
Methods: A prospective observational cross-sectional study was undertaken in Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh; enrolling all patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis and acute mild gall stone induced pancreatitis from October 1, 2019 to September 30, 2020. Case reporting forms and intra-operative severity scoring system devised by Michael Sugrue et al were used. Demographics about the patient and other variables were recorded and intra-operative score was compared with the variables and conversion rates.
Results: A total of 640 patients were enrolled in the study, in which laparoscopic cholecystectomy was attempted, with a mean age of 44.84 years (range 10 to 82 years). The mean duration of surgery was 33.56 minutes. 545 patients (85.2%) had moderate difficulty (score 2-4) in surgery, 39 patients had mild difficulty (score<2), 47 patients had severe difficulty (score 5-7) while 9 patients had extreme difficulty (score 8-10). The conversion rate in this study came out to be 4.2%. Most of these converted surgeries belonged to severe difficulty group (70.4%) (P-value<0.001).
Conclusion: This study provides a simple intra-operative scoring system to grade difficulty of laparoscopic cholecystectomy. Using this score for predicting difficulty and conversion into open surgery allows appropriate planning of laparoscopic cholecystectomy. In patients having high intra-operative difficulty score, early conversion to open cholecystectomy is done to avoid complications, morbidity and mortality.