Development and validation of intraoperative severity score during laparoscopic cholecystectomy- An observational study

Background: Various studies have been carried out to evaluate the risk of pre-operative conversion in laparoscopic cholecystectomy. Different pre-operative scoring techniques have been recommended using different criteria which further add to the controversy. Materials and Methods: This prospective observational study of 100 patients was conducted for 18 months in the Department of General Surgery at AIIMS Bhubaneswar, Odisha, India to grade the severity of cholecystitis during laparoscopic cholecystectomy using the intraoperative scoring system devised by Michael Sugrue and to evaluate the spectrum of cholecystitis in cases of laparoscopic cholecystectomy at a tertiary centre. Patients excluded from study were cases directly taken for open cholecystectomy, Carcinoma gall bladder, emergency cholecystectomy, Age <18> 75 yrs., Pregnancy, ASA-III & IV and Biliary pancreatitis. All the patients were classified on the basis of severity of grading scale as mild, moderate and severe for degree of intraoperative difficulty. Results: In this study group of 100 patients, patients having preoperative imaging showing multiple gall bladder stones, thickened gall bladder wall, male patients, high BMI and patients with intraoperative score between 8-10 with degree of difficulty as extreme had more chances of open conversion. Conclusions: Use of this intra-operative scoring system helped us to provide a trigger for a prompt early conversion to avoid intra-operative complications associated with difficult laparoscopic cholecystectomy.