Page 15 - World Journal of Laparoscopic Surgery

Peroperative Scoring System for Difficult Lap Cholecystectomy
difficult anatomy in an extreme degree of complex cholecystectomy references
is the reason for conversion to open. 15,16 Difficult cholecystectomy
is judged by a few peroperative scoring systems with some amount 1. Murphy JB. The diagnosis of gallstones. Am Med News 1903:
825–833.
of accuracy. 17 2. Litynski GS. Erich Mühe and the rejection of laparoscopic
Recently acute cholecystitis is operated by laparoscopic cholecystectomy (1985): a surgeon ahead of his time. Journal of the
method within 48 hours with the increasing trend rather than Society of Laparoendoscopic Surgeons 1998;2(4):341–346. PMID:
interval cholecystectomy. So, to make the decision for conversion 10036125.
to open surgery intraoperative scoring system will provide 3. Sugrue M, Sahebally SM, Ansaloni L, et al. Grading operative findings
18
indications. Scoring and evaluating intraoperative findings gives at laparoscopic cholecystectomy–a new scoring system. World J
us a standardized protocol to judge the complexity of the disease. Emerg Surg 2015;10:14. DOI: 10.1186/s13017-015-0005-x.
Above all, it guides us to convert the procedure to open and good 4. Solmaz A, Gülçiçek OB, Biricik A, et al. Evaluation of the parameters
increasing intraoperative difficulty scores of elective laparoscopic
outcome measurement with the score. cholecystectomy. J Liver Clin Res 2016;3(1):1023.
In this study chronic calculous cholecystitis has a mean score 5. Gutt CN, Encke J, Koninger J, et al. Acute cholecystitis: early versus
of 5 and acute calculous cholecystitis has a mean score of 6, so delayed cholecystectomy, a multicenter randomized trial (ACDC
even though acute calculous cholecystitis has more degree of study, NCT00447304). Ann Surg 2013;258(3):385–393. DOI: 10.1097/
difficulty according to the scoring system we have managed them SLA.0b013e3182a1599b.
laparoscopically without any complications but the time taken to 6. Takada T, Strasberg SM, Solomkin JS, et al. TG13: Updated
complete acute calculous cholecystitis was around 10 minutes Tokyo Guidelines for the management of acute cholangitis and
more as compared to chronic calculous cholecystitis. cholecystitis. J Hepatobiliary Pancreat Sci 2013;20(1):1–7. DOI: 10.1007/
s00534-012-0566-y.
In this study, 47 (94%) patients have encountered a severe 7. Committee AT, Adler DG, Conway JD, et al. Biliary and pancreatic
amount of complexity. Laparoscopic cholecystectomy was stone extraction devices. Gastrointest Endosc 2009;70(4):603–609.
completed successfully when there was a score of ≤7. It was DOI: 10.1016/j.gie.2009.06.015.
converted to open surgery when the score was ≥8. With a score 8. Pitt HA. Patient value is superior with early surgery for acute
of eight extreme amount of complexity was faced and our three cholecystitis. Ann Surg 2014;259:16–17. DOI: 10.1097/SLA.000000
patients of this score were converted to open surgery. 0000000428.
So, according to our findings higher the peroperative score, 9. Gupta N, Ranjan G, Arora MP, et al. Validation of a scoring system
there might be higher chances of conversion to open surgery, and to predict difficult laparoscopic cholecystectomy. Int J Surg
2013;11(9):1002–1006. DOI: 10.1016/j.ijsu.2013.05.037.
if the score is ≥8 the chances of successful completion of surgery 10. Vivek MA, Augustine AJ, Rao R. A comprehensive predictive scoring
by the laparoscopic method is very low. method for difficult laparoscopic cholecystectomy. J Minim Access
None of our cases had any complications like bile duct injury. Surg 2014;10(2):62–67. DOI: 10.4103/0972-9941.129947.
So, the scoring system has also guided us in the prevention of 11. Surati K, Rathod A, Shah AS. Intraoperative assessment of
life-threatening peroperative complications. laparoscopic cholecystectomy, 2019.
12. Okamoto S, Nakano K, Kosahara K, et al. Effects of pravastatin and
ursodeoxycholic acid on cholesterol and bile acid metabolism in
conclusIon patients with cholesterol gallstones. J Gastroenterol 1994;29(1):
This intraoperative scoring system according to peroperative 47–55. DOI: 10.1007/BF01229073.
finding is important in the evaluation of the mild, moderate, severe, 13. Lal P, Agarwal PN, Malik VK, et al. A difficult laparoscopic
and extreme amount of complexity in carrying out laparoscopic cholecystectomy that requires conversion to open procedure can be
cholecystectomy. According to the scoring system, severe and predicted by peroperative ultrasonography. Journal of the Society
of Laparoendoscopic Surgeons 2002;6(1):59–63. PMID: 12002299.
extreme categories fall into difficult cholecystectomy. Most of 14. Khan IA, El-Tinay OE. Laparoscopic cholecystectomy for acute
the difficult cholecystectomy can be completed laparoscopically cholecystitis: can peroperative factors predict conversion? Saudi
while only an extreme degree of peroperative finding has to be Med J 2004;25(3):299–302. PMID: 15048165.
converted to open surgery thus the scoring system also provides 15. Gupta G, Sharma PK, Gupta S, et al. Pre and per operative prediction
indication for conversion. of difficult laparoscopic cholecystectomy using clinical and
However, this is a small and single-center study. Further, large ultrasonographic parameters. Int J Res Med Sci 2015;3(11):
multicentric study are required. 3342–3346. DOI: 10.18203/2320-6012.ijrms20151188.
16. Peters JH, Krailadsiri W, Incarbone R, et al. Reasons for conversion
from laparoscopic to open cholecystectomy in an urban
clInIcAl sIgnIfIcAnce teaching hospital. Am J Surg 1994;168(6):555–558. DOI: 10.1016/
In mild, moderate, and severe degrees of difficult cholecystectomy s0002-9610(05)80121-7.
according to the peroperative scoring system surgery can be 17. Kwon YJ, Ahn BK, Park HK, et al. What is the optimal time for
successfully completed laparoscopically without complication. On laparoscopic cholecystectomy in gallbladder empyema? Surg Endosc
2013;27:3776–3780. DOI: 10.1007/s00464-013-2968-6.
an extreme level difficult cholecystectomy, peroperative scoring 18. Pisano M, Ceresoli M, Campanati L, et al. Should We must push
system can help and provide guidance for conversion to open for primary surgery attempt in case of acute cholecystitis? A
surgery and also help in preventing life-threatening complications retrospective analysis and a proposal of an evidence based clinical
like bile duct injury. pathway. Emerg Med 2014;4(4):201.

World Journal of Laparoscopic Surgery, Volume 15 Issue 1 (January–April 2022) 13