Predicting Conversion from Laparoscopic to Open Cholecystectomy Using a Perioperative Gallbladder Scoring System

Abstract

Background: Gallstones and associated consequences are a leading cause of elective and emergency laparoscopic and open surgical procedures. Since the first laparoscopic Cholecystectomy in 1985, laparoscopic Cholecystectomy has been the gold standard for treating symptomatic gallstones.

Several pre-operative scoring systems can tell you if a laparoscopic cholecystectomy for gall bladder surgery will be difficult based on different anatomical, imaging, and laboratory findings. However, few intraoperative scoring systems can tell if the surgery will be complicated. Some authors recently considered the most prominent essentials confronting surgeons during laparoscopic Cholecystectomy.

Aim of the study: This study attempted a planned assessment of a recently reported intra-operative gallbladder scoring framework (G10) to decide if it might predict the result of surgery, essentially the ability to complete the operation laparoscopically.

Patient and methods: Eight hundred thirty-seven patients admitted to laparoscopic Cholecystectomy for symptomatic gall stones were enrolled in this prospective study from 1^st January 2018 to 31^st 2021, performed in Rizgary and Hawler Teaching hospitals in Erbil, Iraq.

Results: Among 837 patients, the mean age was 42.3 (range 14–71), 581 (69.4%) were female, and 256 (30.6%) were male. The mean operation time was 32.7 minutes, ranging from 15 to 150 minutes, and 63 (7.6%) patients were converted to open Cholecystectomy because of intraoperative difficulties. The most significant correlations were found with distended and/or contracted gall bladders, the inability to grasp the wall with traumatic forceps, an impacted stone in the Hartman's pouch, and pus or bile outside the gall bladder.

Conclusion: New intraoperative scoring systems are valuable in predicting difficulties and preventing increased operation time and possible injuries; the main points of difficulties are distended or contracted gallbladder, large stone impaction, difficulty grasping the wall of the gall bladder, and the presence of bile or pus outside the gall bladder.