Evaluation of intra-operative gall bladder scoring for predicting conversion of laparoscopic to open cholecystectomy: A prospective observational study in a tertiary care centre in North India

Abstract

Introduction: Laparoscopic cholecystectomy has become the gold-standard treatment for symptomatic cholelithiasis replacing open cholecystectomy. Surprisingly, it has variable outcomes and conversion rates. This single centre, prospective study uses the intra-operative scoring system, devised by Michael Sugrue et al to grade difficulty of laparoscopic cholecystectomy intraoperatively. This score has also been used to predict conversion rates. Methods: A prospective observational cross-sectional study was undertaken in Department of General Surgery, Indira Gandhi Medical College, Shimla, Himachal Pradesh; enrolling all patients undergoing laparoscopic cholecystectomy for symptomatic cholelithiasis and acute mild gall stone induced pancreatitis from October 1, 2019 to September 30, 2020. Case reporting forms and intra-operative severity scoring system devised by Michael Sugrue et al were used. Demographics about the patient and other variables were recorded and intra-operative score was compared with the variables and conversion rates. Results: A total of 640 patients were enrolled in the study, in which laparoscopic cholecystectomy was attempted, with a mean age of 44.84 years (range 10 to 82 years). The mean duration of surgery was 33.56 minutes. 545 patients (85.2%) had moderate difficulty (score 2-4) in surgery, 39 patients had mild difficulty (score