Page 13 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Study of Difficult Laparoscopic Cholecystectomy and Its

Outcome According to Peroperative Scoring System

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Keyur N Surati , Ronak Modi , Sourabh Damani , Kushal Prajapati , Aneri Shah , Monil Patel 6
AbstrAct
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.
Keywords: Cholecystitis, Degree of difficulty, Laparoscopic cholecystectomy, Severity grading.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1485

IntroductIon 1–6 Department of General Surgery, AMC MET Medical College,
Laparoscopic cholecystectomy is one of the commonly performed Ahmedabad, Gujarat, India
general surgical operations both in a planned and emergency Corresponding Author: Keyur N Surati, Department of General
situation. There is lots of evolution in the management of Surgery, AMC MET Medical College, Ahmedabad, Gujarat, India, Phone:
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cholecystitis. Laparoscopic cholecystectomy has done marked +91 9687620125, e-mail: pkushal89.kp@gmail.com
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revolution since it was introduced. Currently cholelithiasis is How to cite this article: Surati KN, Modi R, Damani S, et al. Study of
best managed by laparoscopic cholecystectomy (gold standard Difficult Laparoscopic Cholecystectomy and Its Outcome According to
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method). But difficulty in performing cholecystectomy depends Peroperative Scoring System. World J Lap Surg 2022;15(1):11–13.
on different peroperative findings. The scoring system is helpful in Source of support: Nil
the conversion of laparoscopic cholecystectomy to open to make Conflict of interest: None
the procedure safer surgical practice. If peroperative finding score is
high (≥8) then for prevention of complications like bile duct injury,
or if prolonged time is taken for laparoscopic surgery, the scoring cholecystectomy by means of peroperative scoring system
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system helps in decision making of conversion into open surgery. structured by Sugrue et al. 3
Nowadays the significance of early surgery in acute cholecystitis has
been recommended. There are few international guidelines that Methods And MAterIAls
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suggested a protocol of treatment. According to those guidelines, The study was carried out among 50 patients who underwent
standardized definitions of cholecystitis have been made. 6,7 laparoscopic cholecystectomy admitted to our hospital, AMC
According to those guidelines, there are so many variabilities MET Medical College, Ahmedabad. The study was carried out after
to approach in difficult cholecystectomy by peroperative finding taking permission from the local ethical committee. Patients were
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in management of difficult cholecystectomy. Out of few scoring informed about the procedure and written consent was taken.
systems reported there is no operative definition of findings at Peroperative blood investigations and imaging was done in all
laparoscopic surgery. 9,10 That is why there are hurdles to carry the cases. Elective laparoscopic cholecystectomy was done in
out and compare results or to give a protocol for future study. all the cases and a few of them had acute cholecystitis. We have
This study was carried out to observe peroperative finding and excluded mild and moderate cases of severity index (score <5)
evaluate the amount of complexity in difficult laparoscopic in laparoscopic cholecystectomy. To the best of our knowledge,

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