Prospective Study of Correlation between Nassar Difficulty Grading Scale and perioperative outcomes for laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy has varying degrees of complexity; therefore, it is necessary to systematically identify and classify elements of operative difficulty. Objective: This study aimed to assess the validity and applicability of Nassar difficulty grading scale, correlation between operative findings according to it and perioperative outcomes of laparoscopic cholecystectomy regarding operative time, conversion to open approach, hospital stay, intraoperative and early postoperative complications. Methods: This prospective randomized study was conducted at Department of General Surgery, Tanta University from May 2020 to May 2021. One hundred patients (21 males, 79 females) were included. The age ranged from 22 to 67 years. The Nassar scale was utilized to assess the risk of a difficult cholecystectomy. Intraoperative outcomes evaluated included bleeding, bile and stone spillage, the presence of bowel or biliary injuries, operative time, and the need for conversion to open surgery. Postoperative outcomes recorded were the total length of hospital stay, 30-day complications, the need for reintervention, and mortality. Results: Comparison of Nassar scoring system with outcomes revealed a significant association of rising Nassar grade with bile spillage, stone spillage, bleeding, post-operative drain placement, duration of surgery, and total length of hospital stay. There was no Conversion to open. There was no mortality. The incidence of 30-day reintervention, and complications did not have a significant correlation with high grades. Conclusion: Nassar operating scale is simple scale that can be used by all level of surgeons to predict difficult laparoscopic cholecystectomy. Rising grades have significant correlation with difficulty and complications.