Validation of the Nassar intraoperative grading scale for assessment of laparoscopic cholecystectomy difficulty: A retrospective cohort study

Background: Laparoscopic cholecystectomy (LC) is common, but operative difficulty varies widely. The Nassar intraoperative grading system aims to standardize and predict surgical outcomes. Objective: To assess the degree of difficulty in LC using the Nassar intraoperative scoring system and validate its prediction of conversion and complication rates. Methods: A retrospective cohort of 105 patients undergoing LC (Jan 2023-July 2024) at BGS GIMS Hospital, Bangalore, was analyzed. Intraoperative grading, patient characteristics, conversion rates, and outcomes were recorded and correlated. Results: Mean age was 57.6±16.4 years; 58.1% male. The most frequent indication was cholecystitis (44.8%). Emergency LC was performed in 2.9%. Severe and extreme difficulty was seen in 21.0% and 30.5%, respectively. Overall conversion to open surgery was 8.6%. Conversion rate rose substantially with higher Nassar grade (p